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GYN PT™
Return to GYN Proficiency Testing for 2016 and Save!
Get Faster Results in
Only 7 Days!
Choose your test date and prep type, and get fast results within 7 business days. GYN Proficiency Testing leverages the experience gained from over 35,000 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 2016 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: • Choose a test date 365 days a year. • Choose the slide prep type that mirrors your practice. • Get results faster—in just 7 days!
2016 GYN PT
2016 GYN PT plus Lab Comparison
$995
$1350
PT1-FS
GYN PT™
Program
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–5pm CT) (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.
Price/Program
Quantity
# of Participants/Program
Program Price x Quantity
$995
_____
_____
$ __________________
GYN Proficiency Testing 2016 (PT16) GYN PT and Lab Comparison 2016 (PTLC16)
$1,350 _____ _____ $ __________________ (GYN PT + one shipment of 12 high-quality glass slides with comparative results & statistics) Participant Fee (PTPART16): Total # of Participants for PT _____ x $85 = (enter amount) $ __________________
Subtotal: $ __________________ Recording Fee (PTCLIA16) for each additional CLIA GYN Certificate
__________ x $500 $ __________________
Grand Total $______________
TEST DATE & PREP TYPE CHOICE Indicate your preferred testing date 2016: 1.
/
2.
/
If choosing PT & Lab Comparison*, please indicate in order of preference your date for the single shipment of Lab Comparison:
CAP Accreditation # (If using for CAP LAP purposes):
CLIA #: Lab Director Name: Proctor #1 Name:
2016: 1. Prep Type:
/ ThinPrep
2. 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 #
Proctor Phone:
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 2016 and Save!
Get Faster Results in
Only 7 Days!
Choose your test date and prep type, and get fast results within 7 business days. GYN Proficiency Testing leverages the experience gained from over 35,000 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 2016 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: • Choose a test date 365 days a year. • Choose the slide prep type that mirrors your practice. • Get results faster—in just 7 days!
2016 GYN PT
2016 GYN PT plus Lab Comparison
$995
$1350
PT1-FS
GYN PT™
Program
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–5pm CT) (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.
Price/Program
Quantity
# of Participants/Program
Program Price x Quantity
$995
_____
_____
$ __________________
GYN Proficiency Testing 2016 (PT16) GYN PT and Lab Comparison 2016 (PTLC16)
$1,350 _____ _____ $ __________________ (GYN PT + one shipment of 12 high-quality glass slides with comparative results & statistics) Participant Fee (PTPART16): Total # of Participants for PT _____ x $85 = (enter amount) $ __________________
Subtotal: $ __________________ Recording Fee (PTCLIA16) for each additional CLIA GYN Certificate
__________ x $500 $ __________________
Grand Total $______________
TEST DATE & PREP TYPE CHOICE Indicate your preferred testing date 2016: 1.
/
2.
/
If choosing PT & Lab Comparison*, please indicate in order of preference your date for the single shipment of Lab Comparison:
CAP Accreditation # (If using for CAP LAP purposes):
CLIA #: Lab Director Name: Proctor #1 Name:
2016: 1. Prep Type:
/ ThinPrep
2. 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 #
Proctor Phone:
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.
