First Name:
l;ast Name:
Address:
City:
State:	ME NH
Zip Code:
Home Phone:
Cell Phone:
Work Phone:
Fax Number:
Place of Employment:
Degree(s):
Certification(s):
Years in GI:	1 2 3 4 5 6-10 11-15 16-20 20+
SGNA Member since:
National Activities:	Board of Directors Annual Course Speaker Poster Presentation
Other National Activities:
Regional Activities:	Board of Directors Conference Speaker Conference Host/Planner Website
Other Regional Activities:
Community Activities:
Legislative/Other Activities:
Special Knowledge/Interests:
Why I Love GI:

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