Louisiana Ambulatory Surgery Center Association
P.O. Box 14940
Baton Rouge, LA 70898-4940
(225) 326-3180 Office
(225) 208-1932 Fax
www.la-asa.org
Dear Louisiana Ambulatory Surgery Center,
Attached is a membership application to join the Louisiana Ambulatory Surgery Center Association. Ideally, we
would like to represent 100% of the licensed ASCs in the state of Louisiana. As part of a partnership agreement
with LAMMICO, if your ASC is insured with LAMMICO, they will reimburse 100% of your membership
dues after you pay them to LASCA.
Membership in the Louisiana Ambulatory Surgery Center Association is a wise investment and we have a lot in
store for LASCA members.
YOUR MEMBERSHIP INCLUDES:
 Advocacy – LASCA has a full-time lobbyist who monitors legislative and regulatory threats to
ASCs. The Louisiana Legislature will convene on Monday, March14, 2016 for the Regular Session
of the Louisiana Legislature through June 6, 2016
 Educational Opportunities – LASCA will hold an Annual meeting in January 15, 2016 at the West
Baton Rouge Conference Center, Port Allen. Additionally, LASCA hosts a meeting in conjunction
with the annual Gulf States Conference as well in June
 Our members receive Weekly e-Newsletters to keep them informed with what LASCA is doing for
you and your patients
 Thanks to a partnership between LASCA and LAMMICO, any LASCA member who is
insured by LAMMICO is eligible for a 5% premium discount applied to member facility
medical professional liability premiums when they attend an annual LAMMICO risk
management lecture like the upcoming 2015 Annual Meeting at the West Baton Rouge
Conference Center.
 Networking opportunities
 Access to special discounts from companies who provide goods and services to ambulatory surgery
centers
 Technical Assistance. LASCA has an experienced Executive Director who helps our members get
the technical assistance they need with regulatory or compliance issues.
If you have any questions or would like to discuss membership in LASCA please contact Cindy Bishop at (225)
933-5435 or Sarah Heath, membership director at (225) 326-3180
Respectfully,
Cindy Bishop,
Executive Director / Lobbyist
LOUISIANA AMBULATORY SURGERY CENTER ASSOCIATION
2016 MEMBERSHIP RENEWAL APPLICATION
Applicant Name: __________________________________________________________________________________
Applicant’s ASC: _________________________________________________________________________________
Mailing Address: _________________________________________________________________________________
Address: _______________________________________________
City:
_________
State:
____________
Zip Code:
Telephone #: ________________________________________________Fax #: _________________________________
List Contact Person(s) – (maximum of two) – to whom LASCA information should be sent (Newsletters, special notices)
(1) ___________________________________________
Name
_________________________________________
Title
________________________________________________________________________________________
e-mail address
(2) ___________________________________________
Name
_________________________________________
Title
________________________________________________________________________________________
e-mail 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.
__________________________________________ ____________________________________________ _______________
Signature
Print Name
Date
Annual Dues: $500
You can now renew online at www.la-asa.org
Please make your check payable to LASCA and mail along with the completed membership application
to LASCA
P.O. BOX 14940
Baton Rouge, LA 70898-4940
Louisiana Ambulatory Surgery Association
PO BOX 14940
Baton Rouge, LA 70898-4940
(225) 326-3180 Office
(225) 208-1932 Fax
www.la-asa.org
Louisiana Ambulatory Surgery Center Association &
LAMMICO Partnership
LASCA is pleased to recognize LAMMICO as their preferred provider of medical professional liability
insurance.
Superior reputation protection, risk management education and customer service at the greatest value to local
surgical centers.
Thanks to a partnership between LASCA and LAMMICO, any LASCA member who is insured by LAMMICO is eligible
for a 5% premium discount applied to member facility medical professional liability premiums when they attend an
annual LAMMICO risk management lecture like the upcoming 2015 Annual Meeting at the West Baton Rouge
Conference Center. LAMMICO even reimburses LASCA membership dues after you pay LASCA directly.
Comprehensive coverage and extensive medical professional liability insurance customer service are now available to
ambulatory surgery facilities through LAMMICO.
Each year LAMMICO develops a tailor-made Risk Management program for LASCA members that are given
at the LASCA annual meeting. Members who attend this special Risk Management program are eligible for an
additional 5 percent credit off their LAMMICO basic limits premium.
In addition LAMMICO reimburses the LASCA dues for LAMMICO insureds who are or who wish to
become LASCA members.
When applying for coverage, please note on your application that you are a member of LASCA. For more information
about this program, please call one of our Marketing Representatives serving the following area codes:
504/985: Kendall Ankesheiln, 504/841-5285 kankesheiln@lammico.com
504/985: Kristen Quigley, 504/841-5234 kquigley@lammico.com
337: LAMMICO Marketing Department 800/452/2120 marketing@lammico.com
225: Stan Gavin, 225/281-0241 sgavin@lammico.com
225: Carly Tames, 985/637-6818 cthames@lammico.com
318: Art Adams, 318/219-4922 aadams@lammico.com
318: Cecil Suitt, 501/679/2403 csuitt@lammico.com
To learn more about LAMMICO, visit www.lammico.com.
For more information about becoming a LASCA member, please contact Sarah Heath, LASCA Membership
Director at sarah.heath@checkmate-strategies.com or 225-326-3180.
Louisiana Ambulatory Surgery Center Association
P.O. BOX 14940
Baton Rouge, LA 70898-4940
(225) 326-3180 (Office)
(225) 208-1932 (Fax)
www.la-asa.org
LASCA 2016 Code of Ethics
(Must be signed by each LASCA Member according to LASCA bylaws)

Members shall direct their activities to the mission, goals and objectives of
LASCA, which are to elevate through education the competence, standards and
knowledge of all members.

Members shall not misuse information disseminated in LASCA publications,
meetings, workshops, seminars or other LASCA functions. Misuse of
information includes representing LASCA information to other persons as having
been authored or originated from any person or organization other than LASCA.

Members who also sell products or services shall not utilize information obtained
at LASCA functions such as meetings, workshops or seminars for their personal
financial gain, including the solicitation of such products or services at any time
during LASCA functions, except when acting in the capacity of exhibitor or in the
normal course of membership.

Members shall not disparage the work or conduct of other members, but shall
report unprofessional and/or unethical conduct to the Board of Directors.

Members shall conduct themselves in a professional manner, maintaining a high
personal standard of professional integrity and ethics.
Date: _________________________
Printed Name: _____________________________________________
Title: ____________________________________________________
ASC: ____________________________________________________
Signature: ________________________________________________