2026 Nebraska Annual Meeting Registration Form

2026 Nebraska Chapter Annual Meeting Registration

Friday, April 24, 2026 3pm-8pm
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Member Type*
Please proceed to the Student/Resident Registration form.
Please proceed to the Guest Registration form.
National ACS Membership Number:*
Credentials:*
MD, DO, etc.
Specialty*
General, Vascular, etc.
Institution or Employer*
Other*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

If you have a dietary requirement, please specify:
Please indicate if an ADA (Americans with Disabilities Act) accommodation is required. A staff member will contact you, if necessary.

AudioMobilityVisualOther
Pre-Event Contact: Please select the best method of contact, should we need to reach you in advance of the meeting in case of natural disaster, meeting cancellation, etc.*

Mobile PhoneEmail
Mobile Phone*
Please enter a valid phone number.
Email*
example@example.com
Hold Harmless Waiver

Travel to and attending in person meetings entails the risk of contracting communicable diseases; I agree to waive and hold the Nebraska Chapter of the ACS, the American College of Surgeons, the facility, and each of their agents harmless from and against any liability, damages or expenses arising from travel to or attendance at the event; I agree to follow all health and safety protocols announced by the Nebraska Chapter of the ACS, the facility, and governmental authorities.
I agree to this policy
Notice of Filming and Photography

By attending the 2026 Nebraska Spring Meeting you are participating in an event where photography, audio recording, or video recording may occur. By agreeing to these terms, you consent to photography, audio recording, video recording, and its release, publication, exhibition, or reproduction to be used for promotional purposes, advertising, inclusion on websites, social media, or any other purpose by ACS and its representatives. You release ACS, its employees, and each and all persons involved from any liability connected with the taking, recording, digitizing, or publication and use of interviews, photographs, video, or audio recordings, and you waive all rights to any claims for payment or royalties in connection with any use of these materials. You also waive any right to inspect or approve any photo, video, or audio recording taken by ACS or the person or entity designated to do so by ACS.
I consent to the above photography and other recording consent policy.

My Products*

Faculty Member

$125.00

Test

$1.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

2026 Nebraska Chapter Annual Meeting Registration