Brooklyn Pediatric Society                                            www.bpsny.org

Brooklyn Pediatric Society
                     
[Home]       [Meetings]         [News]       [CME & Other Interesting   Sites]     [Membership]     

                [Hospitals]      [AAP, District & Chapters]      [Career Site]        [Sponsors]  

 

 

Brooklyn Pediatric Society

Membership Application Form

Executive Officers  2008-2009: 

Leslie Alvarado, MD,  President alvaradoleslie@yahoo.com

Roger Kim, MD, Vice President  rkim@brookdale.edu

Elana Altzman, MD,  Secretary  elana@altzman.com

Nitin Ron, MD, Treasurer  nitinron@gmail.com

Levon Agdere, MD, Member-at-large  coolendoman@yahoo.com 

Mary Gallagher, Administrator  pediatricgallagher@yahoo.com 

Website http://www.bpsny.org  Phone:718-780-4892 Fax:718-780-1480

Name

Office Information

Address:

Telephone: Email:
Fax: Website:

Personal Information

Home Address

Telephone:                                         Email:

Education

College:

Medical School:

Training

Internship:

Residency:

Fellowship:

Board Certification Board: Date:
Subspecialty: Date:
Hospital Affiliations 1. 

2.

Society Memberships 1.

2.

References 1.

2.

Comment:

 

_____________________________________                                       ____________

Signature                                                                                                    Date

Annual membership dues are Regular $150,    Retirees $75,    and   Fellows/Residents $50. 

Please submit your check with the completed application to:

The Brooklyn Pediatric Society  c/o Mary Gallagher, Administrator, 413 Vanderbilt Street, Brooklyn, NY 11218  

Email: pediatricgallagher@yahoo.com   Phone:718-780-4892    Fax:718-780-1480 

 

Copyright © 2008