2026 San Diego Annual Meeting Student/Resident Registration Form

2026 San Diego Chapter Annual Meeting Registration

Thursday, May 7, 2026 5:30pm-9pm
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Member Type*
National ACS Membership Number:*
Specialty*
General, Vascular, etc.
Institution or Employer*
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.Format: (000) 000-0000.
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 San Diego 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 San Diego Chapter of the ACS, the facility, and governmental authorities.
*

I agree to this policy

Are you able to pay for your registration today?*

YesNo
The Chapter office administrator, DéJah Jones, will reach out to you directly regarding payment.

My Products*

Student/Resident Member

$40.00

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