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Membership Application

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I am applying for membership in the American Academy ofMedical Administrators.I am also applying for membership in the following Colleges (please check): American College ofCardiovascular Administrators American College ofContingency Planners American College ofHealthcare Information Administrators American College of Managed CareAdministrators American College ofOncology Administrators Federal Sector: Uniformed Services (active, reserve or retired),the Department ofVeteran Affairs and the US Public Health Service

 

Payment must accompany Application (See payment section below)
Your e-mail:
Name in full:
Job title:
Organization Name:
Organization Address:
Office Phone:
Fax Phone:
Active Military:Branch of Service
Rank:
Home Address:
Home Phone:
Date of birth:
Gender: Male Female
EDUCATIONAL BACKGROUND
Name of College/Location (1):
Major (1):
Degree Received (1):
Year Graduated (1):
Name of College (2):
Major (2):
Degree Received (2):
Year Graduated (2):
TWO PROFESSIONALREFERENCES:
Name:
Org:
Address:
Name:
Org:
Address:
Referred by:
The following AAMA member encouraged me to join.
AAMA Affiliate | Name:
Payment Must Accompany Application for Processing
Membership Type:
$145 Member – initial year
$25 Student
Credit Care Type: Mastercard Visa AmEx
Credit Card #:
Expiration Date:
Preferred Mailing Address: Business Home
Preferred Billing Address: Business Home

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 is not deductible because of lobbying activities on behalf of our members. $10.00 of your annual AAMA membership dues includes a subscription to the AAMA Executive. This subscription is a benefit of membership and is not deductible from the annual AAMA membership dues.
 
  

Statement of Integrity of Information

 

By selecting the submit button below, youare indicating that the information contained in this application accurately presents thedata regarding your professional career.