2023 LA-ACS Meeting Registration

LA-ACS Annual Meeting

2023 Registration Form
Name*

First NameLast NameSuffix
Credentials*

MDDOFACSBABSMBBSRNOther
Email*
example@example.com
Cell Phone Number
Please enter a valid phone number.
ACS Member*

YesNo
ACS Member Number
Practice Type*

AcademicPrivate PracticeCommunity Hospital EmployedMixed Model
Institution*

LSU Health New OrleansLSU Health ShreveportOchsner HealthTulane School of Medicine
Institution/Practice Name*
Primary Speciality*

BariatricBreastCardiacColorectalCritical Care/TraumaEndocrineGeneral SurgeryHepatobiliaryNeurologyOb/GynOphthalmologyOrthopedicOtolaryngologyPediatricPlastic/MaxillofacialThoracicUrologyVascularOther
Registration Information
Chapter Membership Type*

Active Member -$125Associate Member -$125Affiliate Member - -$75Retired/Senior Member - $100Medical Student - $0Resident Member - $0Non-Member - $250Other
Saturday, March 25, 2023*

COT Breakfast Meeting (invite only)Speed Mentoring BreakfastMeeting BreakfastPresentationsLA-ACS Business Meeting LunchSurgical Resident JeopardyWomen in Surgery ReceptionNot attending Saturday
Sunday, March 26, 2023*

ePoster SessionMeeting BreakfastPresentationsFinal JeopardyNot attending on Sunday
Speed Mentoring Breakfast for Resident & Medical Students

Help us recruit the right mentors!
Let us know which topics interest you most (or share your own)*

Appying for residency programs (geared towards med students)Applying for fellowship programs (geared towards residents)Private practice vs academics for first jobWork-life BalanceCareer DevelopmentSurgical ResearchOther
Registration Fees
Payment Method*
Check Payment

Your attendance will be confirmed once we receive your check. Mail your check and make payable to:

LA-ACS
2213 Danny Park
Metairie, LA 70001

Questions? Email janna@laacs.org.
Your last name*
Choose One*
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2023 LA-ACS MemberActive, Associate, or Affiliate
$125.00



2023 LA-ACS Associate MemberActive, Associate, or Affiliate
$125.00



2023 LA-ACS Retired/Senior Member
$100.00



2023 Affiliate Member
$75.00



2023 Medical Student
$ Free



2023 Resident
$ Free



Non-Chapter MemberIncludes meeting registration + 2023 LA-ACS membership
$250.00



Total

$0.00
Office Use Only

Should be Empty:

LA-ACS Annual Meeting

Registration Information

Speed Mentoring Breakfast for Resident & Medical Students

Registration Fees

Office Use Only