VA-ACS 2023 Annual Meeting Registration

Thank you for your interest in registering to attend our 2023 Annual Meeting! Please complete the following information to register for the event.

Registrant Name*

First NameLast Name

Registrant Email*

example@example.com

Registrant Phone

Area CodePhone Number

Group/Practice Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I will attend:*

	YES	NO
Friday May 5 Dinner (sponsored by Castle Biosciences)
Saturday, May 6 Continental Breakfast (select if not attending AWS or COT breakfast)
Saturday, May 6 Association of Women Surgeons Breakfast
Saturday, May 6 Committee on Trauma Breakfast
Saturday, May 6 Scientific Session 8AM - 2PM
Boxed Lunch (in vendor area)
Buffet Lunch (sponsored by SpringWorks Therapeutics with speaker)
Saturday, May 6 Social Event (Bold Rock Brewery/Transportation Provided) 3 - 6PM
Sunday, May 7 Breakfast
Sunday, May 7 Scientific Session & Resident Session 8-10AM

Additional Guest Information*

	0	1	2	3
Friday, May 5 Dinner - Number of Additional Guest(s)
Saturday, May 6 Bold Rock Brewery - Number of Additional Guests. Please select $30 Family Fee below if you are adding any guest(s).

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

YesNo

Would you like to add an additional registrant?

YesNo

Registrant Name

First NameLast Name

I will attend:

	YES	NO
Friday May 5 Dinner (sponsored by Castle Biosciences)
Saturday, May 6 Continental Breakfast (select if not attending AWS or COT breakfast)
Saturday, May 6 Association of Women Surgeons Breakfast
Saturday, May 6 Committee on Trauma Breakfast
Saturday, May 6 Scientific Session 8AM - 2PM
Boxed Lunch (in vendor area)
Buffet Lunch (sponsored by SpringWorks Therapeutics with speaker)
Saturday, May 6 Social Event (Bold Rock Brewery/Transportation Provided) 3 - 6PM
Sunday, May 7 Breakfast
Sunday, May 7 Scientific Session & Resident Session 8-10AM

Additional Guest Information

	0	1	2	3
Friday, May 5 Dinner - Number of Additional Guest(s)
Saturday, May 6 Bold Rock Brewery - Number of Additional Guests. Please select $30 Family Fee below if you are adding guest(s)

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

YesNoOther

Book your room early!

Reserve the room that best meets your needs. Book online here or call at 1-800-THE-OMNI and request the VA-ACS discounted room rate of $279.00. Room block expires on April 7, 2023 but rooms may sell out before then.

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.

Payment Method

Pay onlinePay by check

Registration Categories: Please send registration fee corresponding to the number of registrants.

Active Member ~ $240.00Non Member (Join the Chapter and save! www.VirginiaACS.org/membership) ~ $370.00Meeting Speakers ~ $125.00Applicant for Membership (applicants being interviewed for FACS)~ $125.00Resident / Medical Student ~ FREE (must select Pay by Check option to bypass online payment system). If you are bringing a guest, please select the $30 family fee below.Family Fee for Bold Rock Brewery ~ $30.00

Registration Categories: The number of attendees must match the number of payments selected below

Active MemberActive VA-ACS Members

$245.00 Quantity

Non MemberJoin the Chapter and save! Visit www.VirginiaACS.org/membership

$375.00 Quantity

Applicant for MembershipApplicants being interviewed for FACS

$125.00 Quantity

Meeting Speaker

$125.00 Quantity

Resident / Medical Student*Select "pay by check" below to bypass online payment system. Your registration is free. If you are bringing a guest, please select the $30 family fee below.

$ Free Quantity

Family FeeFamily Fee applies to guests for Bold Rock Brewery outing. No additional fee for members to attend the outing.

$30.00

Total

$0.00

Paying by check?

Make check payable to VA-ACS and mail to:

VA-ACS
Attn: 2023 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.

Check payments - do not add online convenience fee.

Payment Methods

Debit or Credit Card

First Name	Last Name
Credit Card Number	Security Code
Card Expiration

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

2023 Annual Meeting

Additional Attendee

Hotel Reservations | Omni Charlottesville Hotel

Reminders

Payments

Pay by Check

Pay Online