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I would like to belong to the following specialty group(s). Please check all that apply (no additional charge):
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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 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
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| My primary Specialty Group will be: (Please check one)
American College of Cardiovascular Administration
American College of Contingency Planners
American College of Federal Healthcare Administrators
(formerly “Federal Sector”)
American College of Healthcare Information Administrators
American College of Managed Care Administrators
American College of Oncology Administrators
American College of Small or Rural Healthcare Administrators
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| Active Military: Branch Rank |
| * Required Field |
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Address Change? Yes No
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| Email:* |
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| Full Name: * |
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| Job Title: |
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| Company: |
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| Primary Address: Business Home |
| Address:* |
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| City:* State:* |
| Zip:* Country: |
| Phone:* Fax: |
| Alternate Address: Business Home |
| Address: |
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| City: State: |
| Zip: Country: |
| Phone: Fax: |
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Check either of the following that are applicable:
CEO/CFO/COO Healthcare Educator Consultant
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| Renewal not valid without payment. |
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Amount: (from invoice)
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| Credit Card: Mastercard Visa AmEx Discover |
| Credit Card #: * |
| Expiration Date: * |
| You can also mail your check or credit card information to the Academy office. Be sure to include expiration date and signature for credit card payments. Checks should be made payable to “AAMA.”
Please remit checks to:
AAMA
701 Lee Street, Suite 600
Des Plaines, IL 60016
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