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Join
- Benefits of Membership
- Categories of Membership
Resources
Advocacy
- Legislative and Regulatory
- Grassroots
Meetings
- 2023 Ambulatory Surgical Facility
  Licensing Seminar
- 2023 Annual Education Conference
  & Trade Show
PAC
Contact

Home
About
Join
- Benefits of Membership
- Categories of Membership
Resources
Advocacy
- Legislative and Regulatory
- Grassroots
Meetings
- 2023 Ambulatory Surgical Facility
  Licensing Seminar
- 2023 Annual Education Conference
  & Trade Show
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 join the listserv, please contact info@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 - $2,779.34
- 1,000 or more cases per year per center - $1,852.09
- 500 or more cases per year per center - $1,389.07
- ASC Not Yet Operational - $648.23
- Single Physician Owned Center under 500 cases per year - $736.63
- Professional Membership - $631.40
Fee Schedule*
- 2,500 or more cases per year per center - $1,389.67
- 1,000 or more cases per year per center - $926.05
- 500 or more cases per year per center - $694.54
- ASC Not Yet Operational - $324.12
- Single Physician Owned Center under 500 cases per year - $368.32
- Professional Membership - $315.70
As a new or renewing member of WASCA, I will make a $1,000 contribution to WASC PAC
- As a new or renewing member of WASCA, I will make a $1,000 contribution to WASC PAC
As a new or renewing member of WASCA, I will make a $500 contribution to WASC PAC
- As a new or renewing member of WASCA, I will make a $500 contribution to WASC PAC
As a new or renewing member of WASCA, I will make a $300 contribution to WASC PAC
- As a new or renewing member of WASCA, I will make a $300 contribution to WASC PAC
As a new or renewing member of WASCA, I will make a $250 contribution to WASC PAC
- As a new or renewing member of WASCA, I will make a $250 contribution to WASC PAC
As a new or renewing member of WASCA, I will make a $250 contribution to WASC PAC
- As a new or renewing member of WASCA, I will make a $250 contribution to WASC PAC
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
As a new or renewing member of WASCA, I will make a $1000 contribution to WASC PAC
- As a new or renewing member of WASCA, I will make a $1,000 contribution to WASC PAC
As a new or renewing member of WASCA, I will make a $500 contribution to WASC PAC
- As a new or renewing member of WASCA, I will make a $500 contribution to WASC PAC
As a new or renewing member of WASCA, I will make a $300 contribution to WASC PAC
- As a new or renewing member of WASCA, I will make a $300 contribution to WASC PAC
As a new or renewing member of WASCA, I will make a $250 contribution to WASC PAC
- As a new or renewing member of WASCA, I will make a $250 contribution to WASC PAC
As a new or renewing member of WASCA, I will make a $250 contribution to WASC PAC
- As a new or renewing member of WASCA, I will make a $250 contribution to WASC PAC
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 $1000
Price:
PAC Contribution $500
Price:
PAC Contribution $300
Price:
PAC Contribution $250
Price:
PAC Contribution $100
Price:
New Member PAC Contribution $1000
Price:
Fees are due upon joining and are billed annually.

*Pursuant to IRS code section 6033(e), WASCA hereby provides notice that 35% of membership dues will be allocated to lobbying activities in 2023. As such, 35 % 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.

Search for:

COVID-19 Resources

Centers for Medicare & Medicaid Services Recommendations -- Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare

Washington State Department of Health 2019 Novel Coronavirus Outbreak Resources

Washington State Department of Health Healthcare Facility Frequently Asked Questions

CDC’s Recommendations for the next 30 days of Mitigation Strategies for Seattle-King, Pierce, and Snohomish Counties based on current situation with widespread COVID-19 transmission and affected health care facilities

ASCA Statement on Elective Surgery and COVID-19

ASCA Guidance for ASCs on Necessary Surgeries

CMS Adult Elective Surgery and Procedures Recommendations: Limit all non-essential planned surgeries and procedures, including dental, until further notice

DOH Notification on Suspension of Inspections

Become a Member

Support Washington ASC Political Action Committee

Washington Ambulatory Surgery Center Association
PO Box 3345
Bellevue, WA 98009
(425) 358-1765
info@wasca.net

WASCA

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