2021 Annual Education Conference & Trade Show Registration - Proliance

Proliance Attendees

Washington Ambulatory Surgery Center Association
2021 Annual Education Conference & Trade Show
Tulalip Resort & Spa
November 4 & 5, 2021

Primary Contact Name*

First Last

Primary Contact Title

Primary Contact Company*

Primary Contact Address

Street Address Address Line 2 City State ZIP Code

Primary Contact Phone

Primary Contact Email*

The Administrative, GI & General Infection Prevention tracks will occur on Friday, November 5. Please indicate the presentation(s) that you wish to attend (if any). Due to restrictions on room capacity, you will need to attend the presentations that you have pre-registered for.

Registration Fees*

WASCA Member - $550.00
Member – Thursday only - $475.00
Member – Friday only - $475.00
Non-Member - $725.00
Non-Member – Thursday only - $650.00
Non-Member – Friday only - $650.00

Additional WASCA Member Registrations

Each additional registration is $450/registrant

Additional Member 1 Name*

First Last

Additional Member 1 Title

Additional Member 1 Company*

Additional Member 1 Address

Street Address Address Line 2 City State ZIP Code

Additional Member 1 Phone

Additional Member 1 Email*

Additional Member 1 - The Administrative, GI & General Infection Prevention tracks will occur on Friday, November 5. Please indicate the presentation(s) that you wish to attend (if any). Due to restrictions on room capacity, you will need to attend the presentations that you have pre-registered for.

Additional Member 2 Name*

First Last

Additional Member 2 Title

Additional Member 2 Company*

Additional Member 2 Address

Street Address Address Line 2 City State ZIP Code

Additional Member 2 Phone

Additional Member 2 Email*

Additional Member 2 - The Administrative, GI & General Infection Prevention tracks will occur on Friday, November 5. Please indicate the presentation(s) that you wish to attend (if any). Due to restrictions on room capacity, you will need to attend the presentations that you have pre-registered for.

Additional Member 3 Name*

First Last

Additional Member 3 Title

Additional Member 3 Company*

Additional Member 3 Address

Street Address Address Line 2 City State ZIP Code

Additional Member 3 Phone

Additional Member 3 Email*

Additional Member 3 - The Administrative, GI & General Infection Prevention tracks will occur on Friday, November 5. Please indicate the presentation(s) that you wish to attend (if any). Due to restrictions on room capacity, you will need to attend the presentations that you have pre-registered for.

Additional Member 4 Name*

First Last

Additional Member 4 Title

Additional Member 4 Company*

Additional Member 4 Address

Street Address Address Line 2 City State ZIP Code

Additional Member 4 Phone

Additional Member 4 Email*

Additional Member 4 - The Administrative, GI & General Infection Prevention tracks will occur on Friday, November 5. Please indicate the presentation(s) that you wish to attend (if any). Due to restrictions on room capacity, you will need to attend the presentations that you have pre-registered for.

Additional WASCA Non-Member Registrations

Each additional registration is $600/registrant

Additional Non-Member 1 Name*

First Last

Additional Non-Member 1 Title

Additional Non-Member 1 Company*

Additional Non-Member 1 Address

Street Address Address Line 2 City State ZIP Code

Additional Non-Member 1 Phone

Additional Non-Member 1 Email*

Additional Non-Member 1 - The Administrative, GI & General Infection Prevention tracks will occur on Friday, November 5. Please indicate the presentation(s) that you wish to attend (if any). Due to restrictions on room capacity, you will need to attend the presentations that you have pre-registered for.

Additional Non-Member 2 Name*

First Last

Additional Non-Member 2 Title

Additional Non-Member 2 Company*

Additional Non-Member 2 Address

Street Address Address Line 2 City State ZIP Code

Additional Non-Member 2 Phone

Additional Non-Member 2 Email*

Additional Non-Member 2 - The Administrative, GI & General Infection Prevention tracks will occur on Friday, November 5. Please indicate the presentation(s) that you wish to attend (if any). Due to restrictions on room capacity, you will need to attend the presentations that you have pre-registered for.

Additional Non-Member 3 Name*

First Last

Additional Non-Member 3 Title

Additional Non-Member 3 Company*

Additional Non-Member 3 Address

Street Address Address Line 2 City State ZIP Code

Additional Non-Member 3 Phone

Additional Non-Member 3 Email*

Additional Non-Member 3 - The Administrative, GI & General Infection Prevention tracks will occur on Friday, November 5. Please indicate the presentation(s) that you wish to attend (if any). Due to restrictions on room capacity, you will need to attend the presentations that you have pre-registered for.

Additional Non-Member 4 Name*

First Last

Additional Non-Member 4 Title

Additional Non-Member 4 Company*

Additional Non-Member 4 Address

Street Address Address Line 2 City State ZIP Code

Additional Non-Member 4 Phone

Additional Non-Member 4 Email*

Additional Non-Member 4 - The Administrative, GI & General Infection Prevention tracks will occur on Friday, November 5. Please indicate the presentation(s) that you wish to attend (if any). Due to restrictions on room capacity, you will need to attend the presentations that you have pre-registered for.

PROLIANCE BILLING

Yes, please bill Proliance for the cost of my meeting attendance.

TOTAL

$0.00

50% refund of registration fees available until September 6, 2021. No refunds will be issued after September 7, 2021. Transfer of registration fees to another colleague or industry member is allowed.

2021 Annual Education Conference & Trade Show Registration – Proliance

WASCA