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Home
About
Join
Resources
Advocacy
- Legislative and Regulatory
- Grassroots
Meetings
PAC
Contact

WASCA Membership Application

Washington Ambulatory Surgery Center Association

PLEASE NOTE: If you plan on paying by check, please print and complete this form and send it in with your payment instead of filling out the form below.
Name of Facility
Address of Facility
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Website
Owner(s)
Please list the name(s) of the owner(s), along with the % owned by doctor, hospital, or other.
Accreditation and Certification
- AAAHC
- AAAASF
- The Joint Commission
- Medicare
If yes to Medicare, please provide the Medicare #
State Licensure
- Licensed
- Exempt
If licensed, please provide the license #
Facility Type
- Single Specialty
- Multi-Specialty
If single specialty, please list the specialty
Personnel
Please update the email addresses for the positions noted at your ASC facility. As a WASCA member, all employees have access to the member listserv. If there are additional employees who would like to receive an invitation to join the listserv, please contact listserv@wasca.net.
Administrator Name
First Last
Administrator Email
Business Manager Name
First Last
Business Manager Email
Clinical Director Name
First Last
Clinical Director Email
Materials Manager Name
First Last
Materials Manager Email
Medical Director Name
First Last
Medical Director Email
Facility & Professional Membership Fee Schedule*
New members receive a 50% discount the first year of membership.
New Member
- I am joining WASCA for the first time
Fee Schedule
- 2,500 or more cases per year per center - $1,650.00
- 1,000 or more cases per year per center - $1,100
- 500 or more cases per year per center - $825.00
- ASC Not Yet Operational - $385.00
- Single Physician Owned Center under 500 cases per year - $385.00
- Single Physician - $385.00
- Professional Membership - $550.00
New Member Fee Schedule
- 2,500 or more cases per year per center - $825.00
- 1,000 or more cases per year per center - $550.00
- 500 or more cases per year per center - $412.50
- ASC Not Yet Operational - $192.50
- Single Physician Owned Center under 500 cases per year - $192.50
- Single Physician - $192.50
- Professional Membership - $225.00
Fees are due upon joining and are billed annually.

*Pursuant to IRS code section 6033(e), WASCA hereby provides notice that 60% of membership dues will be allocated to lobbying activities in 2018.
TOTAL
$0.00
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Card Number Expiration Date Security Code Cardholder Name
INQUIRIES: Contact Emily Jones, Membership Coordinator, at the WASCA office at 206-956-3621 or send emails to emily.jones@wasca.net.

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Announcements

Proposed ASF License Fee Increase

DOH Rulemaking Notice to Increase Initial and Renewal Licensing Fees for ASFs

WASCA Advocates for Surgery Centers with Pending Certificate of Need Exemption Applications

Update on House Bill 2894

WASCA Testifies in Support of House Bill 2894

Department of Health Issues Interpretive Statement Regarding Certificate of Need Review Requirements for Ambulatory Surgical Facilities

Department of Health Determines It Lacks Authority to Grant Exemptions from Certificate of Need Review to Washington’s ASCs

WASCA Files Complaint for Declaratory and Injunctive Relief Against Department of Health Regarding New Rule Subjecting ASF Expansions to Certificate of Need Review

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Upcoming Events

SAVE THE DATE
2019 ANNUAL EDUCATION CONFERENCE & TRADE SHOW

November 14-15, 2019

Tulalip Resort and Casino

Support Our Patients Come First PAC

Washington Ambulatory Surgery Center Association
2001 6th Avenue, Suite 2700
Seattle, WA 98121
(206) 956-3621
info@wasca.net

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