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Ambulatory Surgery Center Association

Call For Topics and Speakers

Suggest a Speaker

ASCs2009

Complete the form to be considered.

You may also download the form and fax or mail it to the ASC Association.

Recommended Topic
Description of Presentation

This topic will be of interest to (check all that apply)

Single specialty Endoscopy ASC Anesthesiologists
Single specialty Ophthalmology ASC Surgeons
Single specialty Orthopedic ASC Administrators
Single specialty Pain Management ASC Directors of Nursing
Owners Business Office Managers
Medical Directors NonManagerial Clinical Staff

Potential speaker

Please fill out as much information as you know. If it is a topic you would like to learn about, and do not have a speaker to recommend, leave blank.

Speaker Name:
Title:
Affiliation:
Address:
City / State / Zip:
Phone Number / Fax Number:
Email:
Recommended by:

Personal Evaluation of Speaking Abilities

ASC Association
1012 Cameron Street
Alexandria, VA 22314
Phone: 7038368808
Fax: 7035490976

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