Excelsior Surgical Society 80/10 Anniversary

Attendee Interest Form

Due: October 4, 2024

Request a Seat Now!

Excelsior Surgical Society 80/10 Anniversary

Back to Rome: Preserving the Heritage and Ethos of Military Surgery

February 18-20, 2025

By completing this form, you are expressing serious interest in attending the Excelsior Anniversary 80/10 Anniversary with intent to register. Payment is not due at this time. You are requesting a seat at the event now, based on a first-come, first-served basis.

Please do NOT book hotel or air travel. ACS will send a link to the registration site and travel/hotel instructions at a later date.

CMEs: Participants can earn CMEs commensurate with the contact hours of the finalized program.

Full Name (as it appears on your government issued ID)*

First NameLast NameMiddle Initial

Credentials

Email Address*

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Mobile Phone Number

Please enter a valid phone number.

Institution*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Are you an Active Military Member?*

Branch of Service

Military Rank

Are you a Veteran?*

ACS Member ID

Do you plan to have a guest accompany you? Guest participation is limited to the tour and the gala dinner.*

YesNo

Thank you!