2024 Individual Membership Renewal

Individual Information

First Name
Last Name
City State Zip
Web Address
Please provide a brief description of service (please note here if you have a center that has not opened)

Membership Fees

Renewals are pro-rated and billed for the annual January payment.

Code of Conduct for CASA Members

By submitting an application for membership or for renewal of membership, the Facility, Individual and/or Vendor acknowledges that it has reviewed the CASA Code of Conduct and Bylaws, and pledges, without reservation to adhere to the standards of practice and conduct set forth therein, with regard to the quality of ambulatory care provided and the management of all other aspects of the member’s operations as well as with regard to participation in the credentialing process itself. To review CASA’s complete Bylaws & Code of Conduct, please visit www.casurgery.org.

I have read and agree to the Code of Conduct for CASA Members
(please initial)
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