MSS Dues Renewal Form

MSS Dues Renewal Form

January 1, 2025 - December 31, 2025
MSS + YOU
Name*

First NameMiddle NameLast NameSuffix
Choose One*

MDDOMD, FACSDO, FACSOther
Preferred Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Practice Type*

AcademicPrivate PracticeCommunity Hospital EmployedMixed Model
Academic Program*

Hennepin HealthcareMayo ClinicUniversity of MinnesotaOther
Institution/Practice Name*
Preferred Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Twitter Handle
Do you have an administrative assistant that you would like us to send announcements about chapter events and programs?*

YesNo
Administrator Name

First NameLast Name
Admin Email
example@example.com
Phone Number
Please enter a valid phone number.
MSS + YOUR Surgical Specialty
Your Discipline

General SurgeryTrauma/Critical CareBreast SurgeryVascular SurgeryTransplant SurgeryThoracic SurgeryCardiac SurgeryOtorhinolaryngologyOrthopedic SurgeryUrologyPediatric SurgeryColorectal SurgerySurgical OncologyPlastic SurgeryMinimally Invasive/BariatricOther
MSS + YOUR Involvement

Get Involved in Your Local Chapter
Yes, I would like to be involved in the following:

MSS CouncilorYoung Fellows Association CommitteeWomen in Surgery CommitteeAdvocacy CommitteeCommission on CancerCommittee on TraumaCommittee ChairAssociate Fellow CommitteeDiversity and Inclusion Committee
MSS + YOUR Membership

MSS Membership Types
I am a*

FellowAssociate FellowAffiliate MemberRetired Member
Member Name*
2025 MSS Dues
Active Fellows

ACS has implemented a new Joint ACS National/Chapter Dues Collection Program to combine the national and chapter Fellow dues into one invoice. You will have the opportunity to pay your 2025 Chapter dues and your 2025 National dues simultaneously.

Once logged in, you may pay your dues online by credit card, or select another payment method (check, ACH, wire, fax, or print an invoice). The College will also send an invoice by both email and mail. All FAQs about this program may be answered Chapter Dues Billing.

To pay your dues, visit the College’s website and login to your online member portal.

www.facs.org
Click “Login” and log in to your account; and
Click your circular profile icon; and
Click “My Dashboard”; and
Click on the “Make a Payment” alert on the top of the Dashboard

Pay by Credit Card (Stripe is our credit card processing company)

Associate Fellow Membership

$175.00

Affiliate Membership

$125.00

Senior/Retired Membership

$75.00

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

Should be Empty:

MSS Dues Renewal Form

MSS + YOU

MSS + YOUR Surgical Specialty

MSS + YOUR Involvement

MSS + YOUR Membership

2025 MSS Dues