2024 LA-ACS Meeting Registration

LA-ACS Annual Meeting

2024 Registration Form
Name*

First NameLast NameSuffix
Credentials*

MDMD, FACSDODO, FACSBABSMBBSRNOther
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 MedicineWillis Knighton Health System
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, April 6, 2024*

COT Breakfast Meeting (invite only)Speed Mentoring BreakfastMeeting BreakfastPresentationsLA-ACS Business Meeting LunchSurgical Resident JeopardyResident Surgical Skills CompetitionNot attending Saturday
Sunday, April 7, 2024*

ePoster SessionMeeting BreakfastPresentationsNot 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)*

Applying 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*

Credit Card Payment

2024 LA-ACS Member | Annual MeetingActive and Associate Members

$125.00

2024 LA-ACS Retired/Senior Member | Annual Meeting

$100.00

2024 Affiliate Member | Annual Meeting

$75.00

2024 Medical Student | Annual Meeting

$ Free

2024 Resident | Annual Meeting

$ Free

Non-Chapter Member | Annual MeetingIncludes meeting registration + 2024 LA-ACS membership

$250.00

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Office Use Only

Should be Empty:

LA-ACS Annual Meeting

Registration Information

Speed Mentoring Breakfast for Resident & Medical Students

Registration Fees

Office Use Only