Thank you for your interest in joining Excelsior Surgical Society!

Please complete the member application below. If you have any questions, you can contact us at excelsior@facs.org

Please note that Excelsior Surgical Society has annual dues of $150, which help support member programs and activities. Dues are waived for Student, Resident, Retired, and Senior members

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* 1. Name

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* 2. Degree and/or credentials (MD, DO, FACS, etc.)

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* 3. Title/salutation

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* 4. ACS ID

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* 5. Surgical Discipline (i.e., General Surgery, Vascular, Trauma, etc.)

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* 6. Institution/Station Information

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* 7. Personal contact information

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* 8. Secondary contact (optional)

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* 9. Date of birth

Date

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* 10. Racial or Ethnic Background (optional)

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* 11. Military Affiliation

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* 12. Branch of Service

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* 13. Current paygrade

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* 14. Current position

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* 15. What category of membership are you applying for? For more information, see our Membership Categories.

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* 16. Confirmation of student/trainee status:

ESS Member dues are waived for medical student and resident members until they complete their training - please upload confirmation of your status as a student and/or trainee. A letter from your program director is sufficient

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* 17. If you are a student, when is your projected graduation date?

Date

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* 18. Upload your current orders:

Members serving on Active-Duty and reserve members who are deployed are eligible for a 50% reduction of ACS Fellow and Associate Fellow Dues. Please upload a copy of your current orders, and we will process the discount.

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