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
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Alabama
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Connecticut
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District of Columbia
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Hawaii
Idaho
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Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
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New Mexico
New York
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
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Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Email
*
example@example.com
Cell Phone
*
Please enter a valid phone number.
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
*
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( X )
Active Member
2025 MSS dues paying member
$
Free
Medical Students, Residents, Trainees
$
Free
Retired/Senior Member
$
Free
Non-Member Fee
includes 2025 MSS membership dues
$
175.00
Credit Card Details
First Name
Last Name
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Security Code
Card Expiration
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