Membership Application

 
 

You can apply for Membership to IAHCSMM by completing the on-line application below. 
If you would rather print out an application to mail or fax in with your payment, click the link for downloadable application (required Adobe Acrobat):

IAHCSMM New Member Application

   
INDIVIDUAL INFORMATION
Name:
Maiden name (if applicable):
Home Address:
Apartment/Suite #:
City, State and Zip:
Home Phone:
Alternate phone (if applicable):
E-Mail address:
 
INSTITUTION INFORMATION
Institution Name:
Institution Address:
 Dept. #:
City/State/Zip:
Institution Phone:
Extension:
Job Title:
 
Please check appropriate box below for membership:
ACTIVE MEMBERSHIP:
Reserved for all personnel
employed in the Healthcare
Central Service Materiel Management
discipline (i.e. Technicians, Supervisors, Managers, Directors, Chiefs or other non-supervisory or lead personnel)
12 months: $40
   
ASSOCIATE MEMBERSHIP:
Reserved for an individual determined
by virtue of his/her practice to
have an allied relationship with a
Healthcare Central Service Materiel
Management Department.
12 months: $40
   

Membership periods begin the date of application approval
and continue thru the next billing period.
From that point forward, membership periods are for 12 month increments
from April 30 until April 29 of the following year.  

I agree, if elected to membership, to be governed by the Constitution and
Bylaws of the Association as long as I continue to be a member.
I furthermore agree to promote the objectives and welfare of the
Association in so far as it is my power. 
   
   
 
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Note: Registration will be completed once payment is received. 

After submitting this form you will be directed to an online shopping cart to make your credit card payment.