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Membership Application

Membership Application

Membership Type Descriptions
Membership Brochure

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 extracharge). Please check all that apply:

Required fields are in red

American College of:

(ACCA)
(ACCP)

(ACHIA)

(ACOA)
(ACSRH)


My primary specialty group will be: Please select one.

American College of:

(ACCA)
(ACCP)

(ACHIA)

(ACOA)
(ACSRH)


Payment Options

Email:  
Name:
Designations: 
Job Title:
Company:

Primary Address:      

Address:
             
City:   State:    Zip:  
Country:
Phone:   
Fax: 
Active Military:    Branch    
                         Rank    

Alternate Address:      

Address:
             
City:   State:    Zip:    Country:
Phone:

General Information

Date of Birth:     Gender:      

Check either of the following that are applicable:
    

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.)

Membership Type Descriptions

Membership Type:   
                           
                           

Payment Must Accompany Application for Processing

Select Payment Type:

Pay Now with Credit Card
               Enter information below:

              Credit Card: 
                       (Please enter numbers only. No separators.)
              Credit Card #:  
              Expiration Date: 
  mm/yy
              First Name: 
              Last Name: 
         Billing address of cardholder:
               Street: 
               City: 
               State: 
  2 letter code
               Zip: 

         Registrations received without payment information will be processed as a payment pending status.
         If not submitting payment online, please print a copy of this form to mail or fax with your payment.
      

       

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.