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NYSAASC 2017 Membership Application (Associate)

New York State Association of Ambulatory Surgery Centers , Inc
2017 NYSAASC Associate Membership Application 

Membership benefits include: a table at NYSAASC Spring and Fall Conferences; seating at Conference Program and Evening Dinner Programs with ASC Administrators and Staff; access to NYSAASC News and Development; and a link to your website on the NYSAASC Website.

To join and/or renew Associate Membership please complete the online registration below or download this form and send complete with a check for annual dues to:

NYSAASC
P.O. Box 8
Elma, NY 14059

2017 Associate Membership Dues are $1000.00 and checks should be made payable to NYSAASC.                                       

WE VALUE YOUR PARTICIPATION
YOU ARE AN IMPORTANT PART OF OUR ORGANIZATION

Primary Contact Name:
Primary Contact Title:
Primary Contact E-mail:
Primary Contact Phone:
-
Company Name:
Describe your product and/or service or business affiliation with ASCs:
Website Address:
Secondary Contact Name:
Secondary Contact Title:
Secondary Contact E-mail:
Secondary Contact Phone:
-
Associate Membership Dues:
 $