Member Application

*All memberships must be paid in full and approved by the Board at the next board meeting for member benefits and access.

* First

* Last

* User ID It must be 5 or more characters in length and may only contain small letters, numbers, and the underscore '_'

* Your Email Address IMPORTANT: This is the e-mail address where all official MSHRM communications will be sent.

* Job Title

Credentials

* Company Name

* Street

* City

* State

* Zip

Country

* Phone

FAX

Home Address

Home City

Home State

Home Zip

Home/Personal Phone

* ASHRM Member? Are you an active member of ASHRM?

I am an active ASHRM member
I am not an active ASHRM member

* Job Responsibilities

My primary job function is healthcare risk management
I manage/supervise individuals whose primary job responsibility is healthcare risk management
In my organization, I have primary responsibility for all healthcare risk management activities
Student
None of the above

* CEO Contact Name

* CEO Contact Email Address

* CEO Contact Phone Number

* Sponsor Contact Name

* Sponsor Contact Email Address

* Sponsor Contact Phone Number

The Following Section is For Student Memberships Only

School Attending

Major / Program Name

School Contact (For Verification)

School Contact Phone

Projected Graduation Date

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