Alabama Association Medical Staff Services
|Membership Application |
|Name |Credentials |
|Job Title |When did you start your career in the credentialing field? |
|Organization Name County |
|Mailing Address |
|City |State |Zip |
|Phone |Fax |
|E-Mail Address |
|Home Address |
|City |State |Zip |
|Home Phone |
|Description of Duties |
| |
|Are you a member of the National Association Medical Staff Services? |
|For more information visit the NAMSS website at |
|What topics would you like to see addressed at AAMSS educational sessions? |
| |
|What do you expect to gain from AAMSS membership? |
| |
|We like to welcome each new member to the group. What is an interesting fact about yourself that most people would not know? What is your favorite |
|hobby? |
| |
|Applicant’s Signature |Date |
| |
|If new member, recruited by: _____________________________________________________________ |
Annual dues are $50. Remittance should accompany this application. Make check payable to Alabama Association Medical Staff Services and mail to:
AAMSS
c/o Alabama Hospital Association
500 North East Boulevard
Montgomery, AL 36117
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