Submit this form to get started
GYN PT™
Return to GYN Proficiency Testing for 2017 and Save!
Get Faster Results in
ONLY 7 DAYS!
Choose any Thursday in 2017 (excluding holidays) to test, select preferred prep type, and get fast results within 7 business days. GYN Proficiency Testing leverages the experience gained from over 40,000 tests, as well as the collective knowledge of ASCP cytopathology experts.
Submit this form to get started or visit ascp.org/gynpt to learn more.
Have you tried Access ASCP? It’s your 1-stop online tool for managing your lab CE and assessment programs and participants. You’ll receive login information for Access ASCP once your 2017 order is placed, allowing you to add or modify participants at any point throughout the year.
Get more with Lab Comparison—For educational purposes, add the Lab Comparison option to get an additional shipment of 12 high-quality glass slides, with comparative results and statistics.
With ASCP’s GYN PT, you can: • Select any Thursday to test. Testing is on a first come, first serve basis. • Choose the slide prep type that mirrors your practice. • Get results faster—in just 7 days!
2017GYN PT
2017 GYN PT plus Lab Comparison
$995
$1350
PT1-FS
GYN PT™
By Fax:
By Phone:
By Mail:
Fax to 312.541.4472 and transmit a copy of your purchase order.
800.267.2727 Monday–Friday (8am–6pm ET) (Outside the US 312.541.4848) Please have credit card information ready.
ASCP 3462 Eagle Way Chicago, IL 60678-1034 Include check payable to ASCP or purchase order.
Program
Price/Program
Quantity
GYN Proficiency Testing 2017 (PT17-GLASS)
$995
_____
# of Participants/Program
Program Price x Quantity
_____
$ __________________
GYN PT and Lab Comparison 2017 (PTLC17)
$1,350 _____ _____ (GYN PT + one shipment of 12 high-quality glass slides with comparative results & statistics) Participant Fee (PT-GLASS-PART): Total # of Participants for PT _____ x $85 = (enter amount) >
Recording Fee (PTCLIA17) for each additional CLIA GYN Certificate
$ __________________
$ __________________
Subtotal: $ __________________
___________________ x $500 $ __________________
Grand Total $______________
TEST DATE & PREP TYPE CHOICE Please mark your desired Thursday early to ensure your preferred testing.
2017: 1.
/
2.
/
3.
/
If choosing PT & Lab Comparison*, please indicate in order of preference your date for the single shipment of Lab Comparison:
2017: 1.
/
2.
/
3.
/
CAP Accreditation # (If using for CAP LAP purposes):
CLIA #: Lab Director Name: Proctor #1 Name: Proctor Phone:
Prep Type:
ThinPrep
SurePath
Conventional
*Lab Comparison is only one way to meet CAP LAP accreditation requirements, and offers up to 6.0 CME/CMLE credits. For a more in-depth education program, consider ASCP GYN Assessment. For more information, check the web at ascp.org.
SHIP CUSTOMER #
Fax:
Proctor Email:
ASCP will follow-up for additional proctor and participant information. ASCP Proctors are available for an additional fee.
BILL CUSTOMER #
Please verify your shipping and billing information. Indicate any changes. SHIPPING ADDRESS:
Purchase Order Number (please attach a copy of the purchase order) BILLING ADDRESS:
Contact Person E-mail (required) Phone
Fax
I want to pay by credit card. Please call me at ________________________________ Date/Time ________________________________________________________________
Important! For your protection, ASCP no longer gathers credit card info via mail or fax. Please call to give ASCP your credit card information.
Return to GYN Proficiency Testing for 2017 and Save!
Get Faster Results in
ONLY 7 DAYS!
Choose any Thursday in 2017 (excluding holidays) to test, select preferred prep type, and get fast results within 7 business days. GYN Proficiency Testing leverages the experience gained from over 40,000 tests, as well as the collective knowledge of ASCP cytopathology experts.
Submit this form to get started or visit ascp.org/gynpt to learn more.
Have you tried Access ASCP? It’s your 1-stop online tool for managing your lab CE and assessment programs and participants. You’ll receive login information for Access ASCP once your 2017 order is placed, allowing you to add or modify participants at any point throughout the year.
Get more with Lab Comparison—For educational purposes, add the Lab Comparison option to get an additional shipment of 12 high-quality glass slides, with comparative results and statistics.
With ASCP’s GYN PT, you can: • Select any Thursday to test. Testing is on a first come, first serve basis. • Choose the slide prep type that mirrors your practice. • Get results faster—in just 7 days!
2017GYN PT
2017 GYN PT plus Lab Comparison
$995
$1350
PT1-FS
GYN PT™
By Fax:
By Phone:
By Mail:
Fax to 312.541.4472 and transmit a copy of your purchase order.
800.267.2727 Monday–Friday (8am–6pm ET) (Outside the US 312.541.4848) Please have credit card information ready.
ASCP 3462 Eagle Way Chicago, IL 60678-1034 Include check payable to ASCP or purchase order.
Program
Price/Program
Quantity
GYN Proficiency Testing 2017 (PT17-GLASS)
$995
_____
# of Participants/Program
Program Price x Quantity
_____
$ __________________
GYN PT and Lab Comparison 2017 (PTLC17)
$1,350 _____ _____ (GYN PT + one shipment of 12 high-quality glass slides with comparative results & statistics) Participant Fee (PT-GLASS-PART): Total # of Participants for PT _____ x $85 = (enter amount) >
Recording Fee (PTCLIA17) for each additional CLIA GYN Certificate
$ __________________
$ __________________
Subtotal: $ __________________
___________________ x $500 $ __________________
Grand Total $______________
TEST DATE & PREP TYPE CHOICE Please mark your desired Thursday early to ensure your preferred testing.
2017: 1.
/
2.
/
3.
/
If choosing PT & Lab Comparison*, please indicate in order of preference your date for the single shipment of Lab Comparison:
2017: 1.
/
2.
/
3.
/
CAP Accreditation # (If using for CAP LAP purposes):
CLIA #: Lab Director Name: Proctor #1 Name: Proctor Phone:
Prep Type:
ThinPrep
SurePath
Conventional
*Lab Comparison is only one way to meet CAP LAP accreditation requirements, and offers up to 6.0 CME/CMLE credits. For a more in-depth education program, consider ASCP GYN Assessment. For more information, check the web at ascp.org.
SHIP CUSTOMER #
Fax:
Proctor Email:
ASCP will follow-up for additional proctor and participant information. ASCP Proctors are available for an additional fee.
BILL CUSTOMER #
Please verify your shipping and billing information. Indicate any changes. SHIPPING ADDRESS:
Purchase Order Number (please attach a copy of the purchase order) BILLING ADDRESS:
Contact Person E-mail (required) Phone
Fax
I want to pay by credit card. Please call me at ________________________________ Date/Time ________________________________________________________________
Important! For your protection, ASCP no longer gathers credit card info via mail or fax. Please call to give ASCP your credit card information.
