Kentucky Chapter Annual Meeting

Contact Information

Name *

First Name Last Name

Credentials *

ACS Member ID

Required for myCME Dashboard

Preferred Email: *

example@example.com

Phone: *

Institution: *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Pre-Event Emergency Contact *

Mobile Phone Home Phone Mobile Email

Onsite Emergency Contact *

COVID-19 Vaccination Policies

Hold Harmless Waiver

On my own behalf and on behalf of those I am registering, I acknowledge that travel to and attending in person meetings entails the risk of contracting communicable diseases; I agree to waive and hold the American College of Surgeons, the facility, and each of their agents harmless from and against any liability, damages or expenses arising from travel to or attendance at the event that result in contracting communicable diseases; I agree to follow all health and safety protocols announced by the American College of Surgeons, the facility, and governmental authorities. I confirm that I am authorized to make these agreements for each of the individuals I am registering.

Hold Harmless Waiver *

I agree

Vaccination Status

To ensure safety for all in-person participants in Lexington, KY, and unless otherwise prohibited by applicable law, 2022 Kentucky Chapter Annual Meeting is a COVID-19 VACCINATION REQUIRED event for all attendees, exhibitors, and staff. Proof of COVID-19 vaccination will be required. In the event one is not vaccinated due to health or religious reasons, results of a daily (taken within 24 hours prior to each meeting day) negative test must be submitted each day of participation. Self-administered tests will not be accepted. Lastly, ACS recommends that masks be worn by all attendees, exhibitors, and staff at all times.

Vaccination Status

I understand that vaccination or a daily negative test (within 24 hours) is required to attend in-person.

How will you be paying?

Check Credit Card

Registration Information

Member - $25 -Associate Fellow, Fellow, Retired, Affiliate of the Kentucky Chapter of the American College of Surgeons – Full Meeting Registration Member -$0 - Medical Students, Residents Non-Member -$125 - Non-member physician - Full Meeting Registration

Check Number

Please make checks payable to:

Kentucky Chapter of the ACS
c/o Linda Silvestri
800 Rose Street
Rm C225
Lexington, KY 40536

My Products

Member Assoc. Fellow, Fellow, Retired, Affiliate Member of the Kentucky Chapter of the American College of Surgeons – Full Meeting Registration

$ 25.00

Non-Member Non-member physician – Full Meeting Registration

$ 125.00

Member Resident Member, Medical Student Member of the Kentucky Chapter of the American College of Surgeons- Full Meeting Registration

Free

Total

$ 0.00

Credit Card