2026 Exhibitor Registration Form

Company Name*

How it will be listed in the final program and signage

Main Contact Name*

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Type of Support

Commercial Promotion*

Commercial Support

Networking Break - $1,250 (3 available)Continental Breakfast - $1,500 (one available)Poster Session - $1,500 (3 Available)Speed Mentoring - $3,500 (with Medical Students & Residents)Attendee Lunch - $2,500Women in Surgery Cocktail Hour - $3,500Resident Surgical Jeopardy - $5,000Exclusive Resident Surgical Skills Round-Up - $7,500

Please check if you need:*

Electrical - $75WifI - $50 per connectionAdditional Badges - $150 eachShipping & Receiving - company expense; will send info once this form is receivedAV equipment - company expense; will send info once this form is receivedNo special requests needed

List Companies you would prefer not to be located nearby

Complimentary Badge #1

First NameLast Name

Email #1

example@example.com

Cell Phone Number

Please enter a valid phone number.

On-Site Contact*

Complimentary Badge #2

First NameLast Name

Email #2

example@example.com

Cell Phone Number

Please enter a valid phone number.

On-Site Contact*

Additional Badge #3

First NameLast Name

Email #3

example@example.com

Cell Phone Number

Please enter a valid phone number.

On-Site Contact*

Additional Badge #4

First NameLast Name

Email #4

example@example.com

Cell Phone Number

Please enter a valid phone number.

On-Site Contact*

Additional Badge #5

First NameLast Name

Email #5

example@example.com

Cell Phone Number

Please enter a valid phone number.

On-Site Contact*

Liability/Insurance: Neither South Texas Chapter ACS nor the hosting facility assume responsibility for any loss, injury or damage occurring to an exhibitor or any exhibitor’s property. It is the exhibitor’s responsibility to have their person and materials insured against theft, damage, loss or injury.

Cancellation: Cancellations will be accepted with written notice on or before December 10, 2025. After December 10, 2025, a 50% cancellation fee will be assessed.

I understand the South Texas ACS exhibitor policies above:*

yesno

Choose Your Payment Method*

Please make check payable to the STC-ACS

Print and submit this form and mail with your check to:

STC-ACS
2213 Danny PK
Metairie, LA 70001

Email: janna@southtexasacs.org
Phone: 504-841-0145
Fax: 504-335-2266

Commercial Promotion

Exhibitor Level

$2,500.00

Exhibitor + Surgical Skills Round-Up

$3,000.00

Bronze Level

$5,000.00

Silver Level

$7,500.00

Gold Level

$10,000.00

Special Requests

WiFi

$50.00

Electricity

$75.00

Enter coupon

Total

$0.00

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

Exhibitor Registration Form

Company Information

Fees

Special Requests

Exhibitor Registration

South Texas Chapter ACS Exhibitor Policies

Payment Method

By Check

By Credit Card