Membership Application

Membership Application

IF YOU ARE ALSO REGISTERING FOR THE CAAMA EXAM. PLEASE COMPLETE THE MEMBERSHIP/EXAM APPLICATION

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I am applying for membership in the American Academy of Medical Administrators. I am also applying for membership in the following specialty groups (no extra charge). Please check all that apply:
American College of Cardiovascular Administrators American College of Contingency Planners American College of Federal Healthcare Administrators (formerly “Federal Sector”) American College of Healthcare Information Administrators American College of Health Plan Management (Formerly American College of Managed Care Administrators) American College of Oncology Administrators American College of Small or Rural Healthcare Administrators I do not wish to join a specialty group at this time My primary specialty group will be: Please select one. American College of Cardiovascular Administrators American College of Contingency Planners American College of Federal Healthcare Administrators (formerly “Federal Sector”) American College of Healthcare Information Administrators American College of Health Plan Management (Formerly American College of Managed Care Administrators) American College of Oncology Administrators American College of Small or Rural Healthcare Administrators
Payment must accompany application (See payment section below)
Email:*
Full Name:*
Designations:
Job Title:
Company:
Primary Address: Business Home
Address:*

City:* State:*
Zip:* Country:
Phone:* Fax:
Active Military: Branch Rank
Alternate Address: Business Home
Address:

City: State:
Zip: Country:
Phone:
General Information
Date of Birth:* Gender: Male Female
Check either of the following that are applicable: CEO/CFO/COO Healthcare Educator Consultant
The following AAMA member-sponsor encouraged me to join: (optional)
Educational Background
College/Location (1):
Major (1):
Degree Received: Year:
College/Location (2):
Major (2):
Degree Received: Year:
Application Code: (optional) (Code is located at bottom right corner of printed application form.)
Payment Must Accompany Application for Processing Membership Type Descriptions
Membership Type: $210 Member $190 Associate Member $45 Student (Proof of Status Required)
Credit Card: Mastercard Visa AmEx Discover
Credit Card #:*
Expiration Date:*

If you prefer to pay with a check, please print a copy of this completed page and mail it with your check to: American Academy of Medical Administrators 701 Lee Street Suite 600 Des Plaines, IL 60016

AAMA Dues are not deductible as a charitable contribution for federal income tax purposes, but may be partially deductible as a business expense. 0% of your AAMA dues are not deductible because of lobbying activities on behalf of our members.