WASCA Membership Application - Auxiliary Membership

Auxiliary Membership
Organization*
Member Contact Name*
First Last
Mailing Address or Business Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Member Contact Email*

As a WASCA member you have access to the member list serv.
Please choose one of the following:*
- Member is not an affiliate of any ASCs
- Member is an affiliate of one or more ASC, and all affiliated ASCs are Facility Members of WASCA
“Affiliate” means, with respect to any entity, any person, corporation, company, individual, or other entity that, directly or indirectly, controls, is controlled by, or is under common control with, such entity. “Control” means the direct or indirect ownership of 50% or more of the equity interests of an entity, or the power to direct or cause the direction of the management and policies of an entity, whether through ownership, by contract, or otherwise.
Fee Schedule*
- Auxiliary Membership - $2,500
As a new or renewing member of WASCA, I will make a $100 contribution to WASC PAC
- As a new or renewing member of WASCA, I will make a $100 contribution to WASC PAC
PAC Contribution $100
Price:
Fees are due upon joining and are billed annually.

*Pursuant to IRS code section 6033(e), WASCA hereby provides notice that 55% of membership dues will be allocated to lobbying activities in 2025. As such, 55% of your dues paid to WASCA are considered non-deductible.
TOTAL
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
INQUIRIES: Contact the WASCA office at info@wasca.net.

WASCA Membership Application – Auxiliary Membership

Auxiliary Membership

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