North Texas Chapter ACS Jeopardy Team Registration

Institution Name*

Institution Name

Main/Admin Contact*

Full Name

Main/Admin Email*

Residents & Medical Students are able to compete in the Chapter competition, regardless of ACS Membership.

The winning team will have an opportunity to enter to compete in the National Surgical Jeopardy Competition at the Clinical Congress in October (ACS will choose the teams who compete, competition is not guaranteed for the North Texas winning team). To be eligible to compete at the national level at Clinical Congress, team members must be Residents or Associate Members of the ACS (medical students cannot compete).

Team Member One*

Full Name

Team Member One Email*

example@example.com

Team Member One Cell Phone*

Area CodePhone Number

Team Member One Residency Year*

Team Member Two*

Full Name

Team Member Two Email*

example@example.com

Team Member Two Cell Phone*

Area CodePhone Number

Team Member Two Residency Year*

Surgical Jeopardy Team Registration