2025 LA-ACS Dues Renewal Form

2025 LA-ACS Dues Renewal Form

January 1, 2025-December 31, 2025
LA-ACS + YOU
Name*

First NameMiddle NameLast NameSuffix
Choose One*

MDDOMD, FACSDO, FACSOther
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Practice Type*

AcademicPrivate PracticeCommunity Hospital EmployedMixed ModelOther
Academic Program*
Institution/Practice Name*
Preferred Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Twitter Handle
Do you have an administrative assistant that you would like us to send announcements about chapter events and programs?*

YesNo
Admin Name

First NameLast Name
Admin Email
example@example.com
Admin Phone Number
Please enter a valid phone number.
LA-ACS + YOUR Surgical Specialty
Your Discipline

General SurgeryTrauma/Critical CareBreast SurgeryVascular SurgeryTransplant SurgeryThoracic SurgeryCardiac SurgeryOtorhinolaryngologyOrthopedic SurgeryUrologyPediatric SurgeryColorectal SurgerySurgical OncologyPlastic SurgeryMinimally Invasive/BariatricOther
LA-ACS + YOUR Involvement

Get Involved in Your Local Chapter
Yes, I would like to be involved in the following:

LA-ACS CouncilProgram CommitteeAssociate Fellow Committee (new)LA-ACS Ambassador ProgramYoung Fellows Association CommitteeWomen in Surgery CommitteeAdvocacy Committee/DayDiversity Committee
LA-ACS + YOUR Membership

Membership Type
I am a(n)*

Associate FellowAffiliate MemberSenior/Retired Member
Member Name*
2025 LA-ACS Dues
Active Fellows

ACS has implemented a new Joint ACS National/Chapter Dues Collection Program to combine the national and chapter Fellow dues into one invoice. You will have the opportunity to pay your 2025 Chapter dues and your 2025 National dues simultaneously.

Once logged in, you may pay your dues online by credit card, or select another payment method (check, ACH, wire, fax, or print an invoice). The College will also send an invoice by both email and mail. All FAQs about this program may be answered Chapter Dues Billing.

To pay your dues, visit the College’s website and login to your online member portal.
- www.facs.org
- Click “Login” and log in to your account; and
- Click your circular profile icon; and
- Click “My Dashboard”; and
- Click on the “Make a Payment” alert on the top of the Dashboard

Pay by Credit Card (Stripe is our credit card processing company)

2025 Associate Fellow DuesMust be recognized by the American College of Surgeons as an Associate Fellow.

$125.00

2025 Senior/Retired Fellow DuesSupport your chapter to continue to engage and mentor young surgeons, trainees, and medical students.

$50.00

2025 Affiliiate DuesNon-FACS Physician, Allied Health Care Professionals, and Nurses.

$75.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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2025 LA-ACS Dues Renewal Form

LA-ACS + YOU

LA-ACS + YOUR Surgical Specialty

LA-ACS + YOUR Involvement

LA-ACS + YOUR Membership

2025 LA-ACS Dues