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 (Required.)

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

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3. Title/salutation (Required.)

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4. ACS ID (Required.)

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

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6. Institution/Station Information (Required.)

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7. Personal contact information (Required.)

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8. Secondary contact (optional)

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9. Date of birth (Required.)

Date

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10. Racial or Ethnic Background (optional)

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11. Military Affiliation (Required.)

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12. Branch of Service (Required.)

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13. Current paygrade (Required.)

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14. Current position (Required.)

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

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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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