MSS Annual Meeting
2025 Registration Form
Name
*
First Name
Last Name
Suffix
Choose all that apply
*
MD
MD, FACS
DO
DO, FACS
MBBS
BA
BS
Other
Practice Type
*
Academic
Private Practice
Community Hospital Employed
Mixed Model
Training Program
*
Hennepin County Medical Center
Mayo Clinic
University of Minnesota
Other
Practice Name
*
City/State
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
*
example@example.com
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Speaker
*
Yes
No
Registration Information
Membership Status
*
Active Member
Non-Member
Retired/Senior Member
Resident Member
Medical Student
Research Trainee
Other
Meeting Days
Friday, October 24, 2025
*
Morning Session
Lunch
Afternoon Session
Not attending on Friday
Saturday, October 25, 2025
*
Breakfast
Meeting
Not attending on Saturday
Registration Fees
*
prev
next
( X )
Active Member
2025 MSS dues paying member
Free
$
Free
Medical Students, Residents, Trainees
Free
$
Free
Retired/Senior Member
Free
$
Free
Non-Member Fee
includes 2025 MSS membership dues
$175.00
$
175.00
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Submit
Should be Empty: