ASA of PA State Office
6449 Snavely Ct.
Harrisburg, PA 17111-4566

Office:  717-545-1217

CLINIC SANCTION

As a condition of obtaining this sanction, the above organization agrees to provide adequate insurance coverage and employ instructors who will provide the highest quality education.

The approved form must be displayed at the clinic in a conspicuous place.

Complete all information and mail with check made payable to "ASA of PA" to: 

ASA of PA, 6449 Snavely Court, Harrisburg, PA 17111-4566

FEE:  $75

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Sponsoring Organization *
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Date of Clinic*
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