Corporate membership will include a complimentary booth and registration to our annual meeting. Corporate members will also have facility membership database and a direct link on our website to be renewed annually. Corporate membership is limited to companies that support ambulatory surgery centers such as medical supply representatives, financial institutions etc.

Please fill-out the form below to become a Corporate Member of IASCA.

Name of Facility:
Address of Facility:
Mailing Address: (If different)
Contact person:
Contact person email:
Contact Phone:
-
Contact Fax:
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CORPORATE MEMBERSHIP

Corporate membership will include a complimentary booth and registration to our annual meeting. Corporate members will also have facility membership database and a direct link on our website to be renewed annually. Corporate membership is limited to companies that support ambulatory surgery centers such as medical supply representatives, financial institutions etc.  Fee for membership is $1,000.00 annually. (which includes display space at our annual meeting) 

ADDITIONAL SUPPORT

Any additional contributions are certainly welcome to help cover our operating expenses and also build a lobbying fund.

Suggested amounts are listed below.
Other:
Credit Card Number:
Expiration Date:
Name on Card:
3 or 4 digit code:
Amount to be charged:
Electronic Signature of CC Holder:
Date: