AMERICAN COLLEGE OF SURGEONS
CHAPTER WEBSITE PROGRAM

 This is not an interactive form. It must be printed and filled out.


Please fill in all fields.

1. CHAPTER NAME:

2. CHAPTER WEBMASTER:


E-mail Address:

Street Address:

Phone:


Fax:

3. We wish to secure the following level of service through Telusys, Inc. (CHECK ONE)--we recommend that chapters consider at least a level II plan so that the webmaster can provide immediate site maintenance.

___ Level I plan ($20/monthly)

___ Level II plan ($35/monthly)

___ Level III plan ($45/monthly)

___ Level IV plan ($85/monthly)
Interactive Website

4. Our chapter wishes to:
a) Design its own website and transfer it to a level on the plan
___ YES ____ NO

b) Pay Telusys to develop our website for a flat fee of $595.00

___ YES ____ NO

4. CHAPTER WEBSITE BILLING INFORMATION SHOULD BE SENT TO:

Name:


Address:

Phone:


Fax:

E-mail Address:

 

5. FOR LEVEL II PLANS AND ABOVE: Chapter website e-mail boxes should be assigned to (list two contacts only):

A) Name:


E-mail Address:

B) Name:


E-mail Address:

 

Return form to: Sally Garneski
Manager, Public Information / Electronic Publishing Division
ACS Communications Department
American College of Surgeons
633 North Saint Clair
Chicago, IL 60611
sgarneski@facs.org
Fax: 312/202-5021

Document Preparation | How to Administer Your Chapter's Website

Chapter Website Application | ACS Chapters

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by the American College of Surgeons, Chicago, IL 60611-3211