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Excelsior Surgical Society Member Application

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
1.Name(Required.)
2.Degree and/or credentials (MD, DO, FACS, etc.)(Required.)
3.Title/salutation(Required.)
4.ACS ID(Required.)
5.Surgical Discipline (i.e., General Surgery, Vascular, Trauma, etc.)(Required.)
6.Institution/Station Information(Required.)
7.Personal contact information(Required.)
8.Secondary contact (optional)
9.Date of birth(Required.)
Date / Time
10.Racial or Ethnic Background (optional)
11.Military Affiliation(Required.)
12.Branch of Service(Required.)
13.Current paygrade(Required.)
14.Current position(Required.)
15.What category of membership are you applying for? For more information, see our Membership Categories.(Required.)
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 / Time
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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