LOUISIANA AMBULATORY SURGERY CENTER ASSOCIATION
Your Name:
Your ASC or Company:
Address:
City, State, Zip:
Telephone #:
Email:
Attendees from your ASC or Company:
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2.)
Name
Title
Email Address
Title
Email Address
I/we hereby apply for membership in the Louisiana Ambulatory Surgery Center Association (LASCA) and agree to abide by such By-Laws and/or rules of the Association which may be enacted. The information herein is true and to the best of my/our knowledge. We hereby apply for membership in the Louisiana Ambulatory Surgery Center Association (LASCA) and agree to abide by such By-Laws and/or rules of the Association which may be enacted. The information herein is true and to the best of my/our knowledge.  By submitting this information below, this is our electronic signature.
By clicking on the submit button below, you will be directed to the payment page.  Annual Dues are $500.00 for LASCA 2017 ACTIVE Membership (January 1, 2017 - December 31, 2017
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$50 per person ~ LASCA Member ASC
$75 per person ~ Members of other state ASC associations 
$250~ Sponsor for Annual Meeting


2019 LASCA Annual Conference 
West Baton Rouge Conference Center
2750 N. Westport Drive
Port Allen, Louisiana​
Friday - January 25, 2019
7:45am - 2:30pm
Breakfast and Lunch Included