Account Options

New Member Application

Join IAHCSMM

You can apply for Membership to IAHCSMM by completing the on-line application below.

First name:
Middle name:
Last name:
Home address:
Home City:
Home State/Province:
Home Zip/Postal Code:
Country (if Canada or overseas):
Home phone:
Home phone country code (if applicable):
Alternative Phone:
Alt. phone country code (if applicable):
Email:
Name of hospital or institution:
Institution address:
Institution City:
Institution State/Province:
Institution Zip/Postal Code:
Institution Country (if Canada or overseas):
Job title:
Other Designation (RB, BSN, etc):
Membership Type:
Please indicate how you would like to receive Communique:
Please indicate how you'd like to receive Central Source (IAHCSMM’s online monthly newsletter):
Send industry mail to:
Send industry email to:

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