ACS Oregon Chapter Member Registration and Dues Payment Form

ACS members in Oregon who are also current ACS national members are encouraged to support the Oregon Chapter of the ACS. Annual dues are $100. Dues statements are sent in December. The Oregon Chapter of the ACS provides advocacy in the state legislature and government agencies, an annual conference jointly held with the Washington ACS chapter, newsletters, and other social and educational events.

Member Contact Information

* First Name

Middle Name

* Last Name

* Credentials

* Address 1

Address line 2 (apt, suite, etc)

* City

* State

* Postal Code

* Email Address

Phone

* Membership Class

ACS Fellow

Resident (no Chapter dues are owed)

Associate (Non physician, Allied Health Professionals, Nurses)

ACS Candidate

Contact me about serving on the Oregon ACS Council

Yes

* Membership Dues, ACS Oregon Chapter

Oregon Chapter Dues ($100 ACS Fellows, Annual)

Optional: ACS Oregon foundation donation (Suggested $100)

* Method of Payment

Check (send in mail)

Call in credit card (Call office to run card)

Pay by PayPal

Make checks payable to:
"Oregon Chapter, American College of Surgeons"
c/o Spire Management
3340 Commercial St SE Su 220
Salem, OR 97302

To pay by credit card, contact the Oregon Chapter Office at 503-371-7457.

Questions? Contact Harvey Gail, ACS Oregon Chapter Administrator, 503-371-7457.
ACS Oregon Tax ID: 93-6090977

* Indicates Response Required