2023 Ambulatory Surgical Facility Licensing Seminar

The Washington State Department of Health and industry leaders will present on current issues critical to state licensing and regulation of ambulatory surgical facilities.

Seattle Art Museum

1300 1st Avenue

Seattle, WA 98101

March 3, 2023

10:00 a.m. – 4:00 p.m.

ASF Licensing Seminar Agenda

Registration
Name*
First Last
Title*
Company*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Registration Fees*
- Member - $239.00
- Non-member - $379.00
Additional Attendees: Member clinics*
Each additional attendee from the same clinic may register for $225 each.
Additional Attendees: Non-member clinics*
Each additional attendee from the same non-member clinic may register for $345 each.
Additional Attendee Contact Information

Please let us know the name, title, and email for each additional attendee from the member clinic
Additional Attendee #1 Name*
First Last
Additional Attendee #1 Title*
Additional Attendee #1 Email*
Additional Attendee #2 Name*
First Last
Additional Attendee #2 Title
Additional Attendee #2 Email*
Additional Attendee #3 Name
First Last
Additional Attendee #3 Title
Additional Attendee #3 Email
Additional Attendee #4 Name
First Last
Additional Attendee #4 Title
Additional Attendee #4 Email
Additional Attendee #5 Name
First Last
Additional Attendee #5 Title
Additional Attendee #5 Email
Additional Attendee #6 Name
First Last
Additional Attendee #6 Title
Additional Attendee #6 Email
TOTAL
$0.00
CREDIT CARD*
Visa, MasterCard, American Express, Discover

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

Registration
Name*
First Last
Title*
Company*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Registration Fees*
- Member - $239.00
- Non-member - $379.00
Additional Attendees: Member clinics*
Each additional attendee from the same clinic may register for $225 each.
Additional Attendees: Non-member clinics*
Each additional attendee from the same non-member clinic may register for $345 each.
Additional Attendee Contact Information

Please let us know the name, title, and email for each additional attendee from the member clinic
Additional Attendee #1 Name*
First Last
Additional Attendee #1 Title*
Additional Attendee #1 Email*
Additional Attendee #2 Name*
First Last
Additional Attendee #2 Title
Additional Attendee #2 Email*
Additional Attendee #3 Name
First Last
Additional Attendee #3 Title
Additional Attendee #3 Email
Additional Attendee #4 Name
First Last
Additional Attendee #4 Title
Additional Attendee #4 Email
Additional Attendee #5 Name
First Last
Additional Attendee #5 Title
Additional Attendee #5 Email
Additional Attendee #6 Name
First Last
Additional Attendee #6 Title
Additional Attendee #6 Email
TOTAL
$0.00
CREDIT CARD*
Visa, MasterCard, American Express, Discover

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

2023 Ambulatory Surgical Facility Licensing Seminar

Registration

Additional Attendee Contact Information

Registration

Additional Attendee Contact Information

WASCA