Individual Life Membership Price: $400 First Name:* First Name Required Last Name:* Last Name Required Specialty:* Specialty is Required Addiction MedicineAllergy/ImmunologyAnesthesiologyCardiac ElectrophysCardiac SurgeryCardiologyCardiovascularChild PsychiatryClinical PathologistColo-rectal SurgeryDentistryDermatologyDiagnostic RadiologyEmergency MedicineEndocrinologyENTFamily MedicineFamily PracticeGastroenterologyGeneral PracticeGeneral SurgeryGeriatric MedicineGeriatricsGynecologyHand SurgeryHead Neck SurgeryHematologyHematology-OncologyInfectious DiseaseInterventional CardiologyInternal MedicineNeonatal MedicineNeonatologyNephrologyNeurologyNeurosurgeryNuclear MedicineOB/GYNOncologistOncologyOphthalmologyOrthopedicsOther SpecialistsPain ManagementPathologyPediatric Emergency MedicinePediatricsPharmacologyPhysMedicine RehabPlastic SurgeryPreventive MedPsychiatryPulmonary Critical CarePulmonary MedicineRadiation OncologyRadiologyRheumatologySurgeryThor/Vasc/GenUrologyVascular SurgeryRetired Physician Medical License Number:* Medical License Number is Required Home Phone: Home Phone is not valid Home Street Address: Home Street Address is not valid Home City: Home City is not valid Home State: Home State is not valid Home Zip: Home Zip is not valid Username:* Invalid Username Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match Password Strength Password must be "Medium" or stronger Description Amount Individual Life Membership – Payment $400.00 Total $400.00 Select Payment Method Pay by PayPal (or Credit Card) Pay by Check Pay by Zelle ( tipsnechapter@yahoo.com ) Pay via your PayPal account Please mail the Check Payment to the following address: 1706 N. Britain Rd. Irving, TX 75061 Your order will be processed once your payment is received. If you have any questions, please email us at information@tipsnec.org Please send the Zelle Payment to tipsnechapter@yahoo.com Your order will be processed once your payment is received. If you have any questions, please email us at information@tipsnec.org I have read and agree to the Terms of Service* No val Please fix the errors above
