ACS 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
Division of Integrated Communications
American College of Surgeons
633 North Saint Clair
Chicago, IL 60611
sgarneski@facs.org
Fax: 312-202-5021