FL 2025 Institutional Sponsorship

2025 Institutional Sponsorship
Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Institution Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Institution Name*
Institution's Logo*

Your institution’s logo will be displayed on the Chapter sponsorship page to highlight our partners.
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Program Link*
Along with your institution’s logo, a link to your program will be displayed on the Chapter sponsorship page .
Please choose your institution's level of sponsorship:*

Silver Level Sponsor
Please provide names and email addresses for up to 10 residents to receive complimentary membership in the Florida Chapter:
Names and email addresses can be submitted at a later date if they are not available now.
Gold Level Sponsor
Please provide names and email addresses for up to 15 residents to receive complimentary membership in the Florida Chapter:
Names and email addresses can be submitted at a later date if they are not available now.
As a Gold level sponsor, your institution is entitled to a job posting on the Chapter's website.

You may upload a file now, or submit your posting at a later date.
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Platinum Level Sponsor
Please provide names and email addresses for up to 40 residents to receive complimentary membership in the Florida Chapter:
Names and email addresses can be submitted at a later date if they are not available now.
As a Platinum level sponsor, your institution is entitled to a job posting on the Chapter's website.

You may upload a file now, or submit your posting at a later date.
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Please provide the names of the faculty (as you would like them to appear) to be listed on the Florida Chapter website:
Faculty member names can be submitted at a later date if they are not available now.

Payment Information
How will you be paying?*

CheckACHCredit Card**
**A 3% processing fee will be added to credit card transactions.
Membership Level*

2025 Platinum Institutional Sponsor - $5,0002025 Gold Institutional Sponsor - $4,0002025 Silver Institutional Sponsor - $3,000
Check Number
Total Due
If you would like to pay by ACH, please contact the Florida Chapter at Florida@affinity-strategies.com after you submit your form. Include the subject line: Florida Chapter Institutional Sponsor ACH payment request.
To request an invoice, please contact the Florida Chapter at Florida@affinity-strategies.com after you submit your form. Include the subject line: Florida Chapter Institutional Sponsor invoice request.
Checks can be made payable to:

Florida Chapter of the American College of Surgeons
c/o Affinity Strategies
PO Box 1488
Warrenville, IL 60555

My Products*

2025 Platinum Institutional Sponsor

$5,000.00

2025 Gold Institutional Sponsor

$4,000.00

2025 Silver Institutional Sponsor

$3,000.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

2025 Institutional Sponsorship