2023 Annual Education Conference & Trade Show Registration

Washington Ambulatory Surgery Center Association
2023 Annual Education Conference & Trade Show
Tulalip Resort & Spa
10200 Quil Ceda Boulevard
Tulalip, WA 98271
November 9 & 10, 2023

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 10. Please indicate the presentation(s) that you wish to attend (if any).

General Infection Prevention: 10:30 - 11:30 a.m.
General Infection Prevention: 11:30 - 12:30 p.m.
Administrative Track: 10:30 - 11:30 a.m.
Administrative Track: 11:30 - 12:30 p.m.
GI Track – Infection Prevention: 10:30 - 11:30 a.m.
GI Track – Infection Prevention: 11:30 - 12:30 p.m.

Registration Fees*

WASCA Member - $650.00
Member – Thursday only - $575.00
Member – Friday only - $575.00
Non-Member - $825.00
Non-Member – Thursday only - $750.00
Non-Member – Friday only - $750.00
Additional Member Rate - $550

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 / Province / Region ZIP / Postal Code Country

Additional Member 1 Phone

Additional Member 1 Email*

Additional Member 1 - The Administrative, GI & General Infection Prevention tracks will occur on Friday, November 10. Please indicate the presentation(s) that you wish to attend (if any).

General Infection Prevention: 10:30 - 11:30 a.m.
General Infection Prevention: 11:30 - 12:30 p.m.
Administrative Track: 10:30 - 11:30 a.m.
Administrative Track: 11:30 - 12:30 p.m.
GI Track – Infection Prevention: 10:30 - 11:30 a.m.
GI Track – Infection Prevention: 11:30 - 12:30 p.m.

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 / Province / Region ZIP / Postal Code Country

Additional Member 2 Phone

Additional Member 2 Email

Additional Member 2 - The Administrative, GI & General Infection Prevention tracks will occur on Friday, November 10. Please indicate the presentation(s) that you wish to attend (if any).

General Infection Prevention: 10:30 - 11:30 a.m.
General Infection Prevention: 11:30 - 12:30 p.m.
Administrative Track: 10:30 - 11:30 a.m.
Administrative Track: 11:30 -1 2:30 p.m.
GI Track – Infection Prevention: 10:30 - 11:30 a.m.
GI Track – Infection Prevention: 11:30 - 12:30 p.m.

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 / Province / Region ZIP / Postal Code Country

Additional Member 3 Phone

Additional Member 3 Email*

Additional Member 3 - The Administrative, GI & General Infection Prevention tracks will occur on Friday, November 10. Please indicate the presentation(s) that you wish to attend (if any).

General Infection Prevention: 10:30 - 11:30 a.m.
General Infection Prevention: 11:30 - 12:30 p.m.
Administrative Track: 10:30 - 11:30 a.m.
Administrative Track: 11:30 - 12:30 p.m.
GI Track – Infection Prevention: 10:30 - 11:30 a.m.
GI Track – Infection Prevention: 11:30 - 12:30 p.m.

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 / Province / Region ZIP / Postal Code Country

Additional Member 4 Phone

Additional Member 4 Email*

Additional Member 4 - The Administrative, GI & General Infection Prevention tracks will occur on Friday, November 10. Please indicate the presentation(s) that you wish to attend (if any).

General Infection Prevention: 10:30 - 11:30 a.m.
General Infection Prevention: 11:30 - 12:30 p.m.
Administrative Track: 10:30 - 11:30 a.m.
Administrative Track: 11:30 - 12:30 p.m.
GI Track – Infection Prevention: 10:30 - 11:30 a.m.
GI Track – Infection Prevention: 11:30 - 12:30 p.m.

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 / Province / Region ZIP / Postal Code Country

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 10. Please indicate the presentation(s) that you wish to attend (if any).

General Infection Prevention: 10:30 - 11:30 a.m.
General Infection Prevention: 11:30 - 12:30 p.m.
Administrative Track: 10:30 - 11:30 a.m.
Administrative Track: 11:30 - 12:30 p.m.
GI Track – Infection Prevention: 11:30 - 11:30 a.m.
GI Track – Infection Prevention: 11:30 - 12:30 p.m.

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 / Province / Region ZIP / Postal Code Country

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 10. Please indicate the presentation(s) that you wish to attend (if any).

General Infection Prevention: 10:30 - 11:30 a.m.
General Infection Prevention: 11:30 - 12:30 p.m.
Administrative Track: 10:30 - 11:30 a.m.
Administrative Track: 11:30 - 12:30 p.m.
GI Track – Infection Prevention: 10:30 - 11:30 a.m.
GI Track – Infection Prevention: 11:30 - 12:30 p.m.

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 / Province / Region ZIP / Postal Code Country

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 10. Please indicate the presentation(s) that you wish to attend (if any).

General Infection Prevention: 10:30 - 11:30 a.m.
General Infection Prevention: 11:30 - 12:30 p.m.
Administrative Track: 10:30 - 11:30 a.m.
Administrative Track: 11:30 - 12:30 p.m.
GI Track – Infection Prevention: 10:30 - 11:30 a.m.
GI Track – Infection Prevention: 11:30 - 12:30 p.m.

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 / Province / Region ZIP / Postal Code Country

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 10. Please indicate the presentation(s) that you wish to attend (if any).

General Infection Prevention: 10:30 - 11:30 a.m.
General Infection Prevention: 11:30 - 12:30 p.m.
Administrative Track: 10:30 - 11:30 a.m.
Administrative Track: 11:30 - 12:30 p.m.
GI Track – Infection Prevention: 10:30 - 11:30 a.m.
GI Track – Infection Prevention: 11:30 - 12:30 p.m.

TOTAL

$0.00

CREDIT CARD*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

50% refund of registration fees available until Friday September 8, 2023. No refunds will be issued as of September 9. Transfer of registration fees to another colleague or industry member is allowed.

INQUIRIES: Contact the WASCA Office at info@wasca.net