American Council of Academic Plastic Surgeons
Winter Registration

Note: All fields are required.

REGISTRANT INFORMATION
Registration Type Non-member ($350.00)
Resident/Fellow/Medical Student ($125.00)
Name
Institution
Address
City
State
Zip
Country:
Phone:
Email:
Specialty:

BILLING INFORMATION Same as Purchaser
Name on Card:
Billing Address:
City:
State:
Zip:
Country:

PAYMENT
Discount Code:
Total:
Credit Card Type:
Credit Card Number:
Expiration Date:
Card Security Code:
 
Cancellation/Refund Policy
All requests for cancellations must be received in writing. If a written request of cancellation is received at the Council's Administrative Office on or before January 27, 2021, the registration fee, less a $25.00 administrative fee, will be refunded after the meeting. Refund requests received after January 27, 2021 will not be honored.