2022 Northwest Medical Laboratory Symposium Virtual

Name *

First Name Last Name

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Email *

example@example.com

Phone Number

Area Code Phone Number

Facility

Facility City/State

The Virtual NWMLS will be conducted via Zoom. As we get closer to the meeting, you will be emailed instructions for accessing the sessions. Your registration gives you access to all sessions onall three days, along with access to the recorded sessions. If you have not used Zoom before, you are encouraged to go to www.zoom.us/test. If you are on a computer, it will ask you to allow download of the Zoom file. Please say yes. You will be able to test your microphone and speakers in the test website above. If you are using your smartphone or a tablet, please go to your respective app store and download the Zoom app.

Your registration allows you access to the live sessions and to the recorded sessions afterwards. If you are unable to catch a session at its stated time, you can view it later at your convenience. Both live and recorded sessions are eligible for P.A.C.E. Credit.

Membership, Select only one please. *

ASCLS AMT Phlebotomist/RMA NonMember Student, must currently be in an approved program

If you select the student category, you must fill in the name of where your program is and the city/state. Failure to do this will result in a hold on your registration.

If Student, type in Facility or Program Name

Student Program City/State

Registration: Please select one.

Full Conference Registration, ASCLS or AMT Member Registration for both days.

$ 60.00

Full Conference Registration, NonMember Registration for both days

$ 80.00

Full Conference Registration, Phlebotomist/RMA Registration for both days

$ 30.00

Full Conference Registration, Student Registration for both days

$ 10.00

Total

$ 0.00

Credit Card

Your credit card information is processed at a secure site, Jotform.com and Square.com. The credit card information is not received or retained by ASCLS-WA, only the fee paid information is provided to us along with your demographic information.