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Virginia Association of Surgical Assistants
Office of Health Professions
Lewis Hall; Suite 1100
2007-2008 Member/New Member Application
Name _________________________________________________________________
(last) (first) (m initial)
Address ________________________________________________________________
(street)
________________________________________________________________________
(city) (state) (zip)
________________________________________________________________________
(E-mail) (Phone#)
I hereby join/renew membership to the Virginia Association of Surgical Associates:
________________________________________________________________________
(Signature)
Members and New Members should send this form with their annual membership dues for year 2007-08 (Jun-May) to the address listed above. Checks must be payable through a U.S. bank. Please check appropriate level category:
Certified Member, ($35): □
This term shall apply to all persons who are actively practicing as Non-Physician surgical Assistants in the State of Virginia who join the VASA as a Certified Member by successfully passing the National Surgical Assistant Association (NSAA) Certification Examination and is in good standing with the NSAA. Certified Members shall have full voting rights in the VASA.
Associate Member, ($35): □
This term shall apply to all persons who are actively practicing as Non-Physician Surgical Assistants in the State of Virginia that have not been certified by NSAA as a Certified Surgical Assistant (CSA). Associate Members shall have full voting rights in the VASA.
Student Member, ($10): □
This term shall apply to all persons who are enrolled in an NSAA approved surgical assistant school/program. Student Members shall not have voting rights in the VASA.