MNASCA MEMBERSHIP APPLICATION - mnasca org 2025

1. Click ‘Get Form’ to open the MNASCA MEMBERSHIP APPLICATION in our editor.
2. Begin by entering the Legal Name of your Facility, followed by the Address, City/State/Zip, and Telephone number. Ensure all details are accurate for processing.
3. In the 'Legal Type' section, select the appropriate option that describes your facility's legal structure. This includes choices like LLC, Corporation, or Sole Proprietor.
4. Complete the 'Membership Requirement' section by checking off any applicable licenses or certifications you possess, such as a Minnesota License or Medicare number.
5. Fill out the 'Facility Type' section by selecting your facility's classification and providing additional details if necessary, such as the Number of Operating Suites and Annual Number of Surgeries.
6. Provide contact information for key personnel including Administrator, Medical Director, and Clinical Director. Include their direct dial numbers and emails for efficient communication.
7. Review the Membership Fee Schedule and select the appropriate membership type based on your facility's annual surgeries. Make sure to note the fee associated with your choice.
8. Finally, ensure you enclose a copy of one of the previous Certificates along with your payment before submitting your application to MNASCA at the provided address.

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