VA-ACS 2022 Annual Meeting Registration

2022 Annual Meeting

April 29 & 30, 2022 | Kingsmill Resot
Thank you for your interest in registering to attend our 2022 Annual Meeting! Please complete the following information to register for the event.
Registrant Name *

First Name Last Name
Registrant Email *
example@example.com
Registrant Phone

Area Code Phone Number
Group/Practice Name *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

I will attend: *

	YES	NO
Friday April 29 Reception
Friday April 29 Reception guest (family fee applies for guests)
Saturday, April 30 Association of Women Surgeons Breakfast
Saturday, April 30 Continental Breakfast (select if not attending AWS breakfast)
Saturday, April 30 Scientific Session 8AM - 5PM
Saturday, April 30 Resident Reception
Saturday, April 30 Resident Reception guest

I give permission for the VA-ACS to share my contact information (name, city, email address) with the vendors.

Yes No
Attendees
Would you like to add additional registrants? *

Yes No
Please enter the following information for each attendee:
Hotel Reservations | Kingsmill Resort

1010 Kingsmill Rd, Williamsburg, VA 23185
Book your room early! A block of rooms has been reserved at the discounted rate of $195.00. To book the room that best accommodates your needs, please call Resort Reservations at (757) 253-1703. Hurry! The room block expires on April 8, 2022 but rooms may sell out before then.
Reminders
Cancellation policy: Full refund (less $10 admin fee) 14 days prior to the event date. 50% refund (less $10 admin fee) 5-14 days prior to the event. No refund 5 days or less prior to the meeting.
Questions? Contact Susan McConnell, Chapter Administrator, at 804.622.8139 or smcconnell@ramdocs.org.
Payments

Pay online now or send a check later. (IMPORTANT: All resident/medical student registrations MUST select pay by check to bypass online payment system)
Payment Method

Pay online Pay by check
Payment Details
Registration Categories: The number of attendees must match the number of payments selected below

Active Member ~ $230.00 Non Member (Join the Chapter and save! www.VirginiaACS.org/membership) ~ $300.00 Meeting Speakers AND Applicant for Membership (applicants being interviewed for FACS)~ $115.00 Resident / Medical Student ~ FREE (must select Pay by Check option to bypass online payment system) Family Fee (add $30 if a guest will attend the Welcome Reception on Friday, April 29)
Registration Categories: The number of attendees must match the number of payments selected below
prev next ( X )
Active Member Active VA-ACS Members
$ 230.00 Quantity

Non Member Join the Chapter and save! Visit www.VirginiaACS.org/membership
$ 300.00 Quantity

Applicant for Membership Applicants being interviewed for FACS
$ 115.00 Quantity

Meeting Speaker
$ 115.00 Quantity

Resident / Medical Student *Select "pay by check" below to bypass online payment system. Your registration is free.
Free Quantity

Family Fee Friday, April 30 | Reception fee for guests
$ 30.00 Quantity

Total

$ 0.00
Paying by check?

Make check payable to VA-ACS and mail to:

VA-ACS
Attn: 2022 Annual Meeting Registration
2821 Emerywood Parkway, Ste. 200
Richmond, VA 23294

Resident / Medical Students must select "Pay by Check" to bypass online payment system, but are not required to send payment.

Payment Methods

Debit or Credit Card

First Name	Last Name
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Please click one of the PayPal options to complete payment and submit the form.

Should be Empty:

2022 Annual Meeting

Attendees

Hotel Reservations | Kingsmill Resort

Reminders

Payments

Payment Details