RMGMA 2023 Membership Application

2023 Membership Application

Thank you for your interest in joining the RMGMA! Please complete the application below. Contact Carly Miller cmiller@ramdocs.org with any questions.
Name*

First NameLast Name
Employer Address:*

Employer Name

Street Address

CityState / Province

Postal / Zip CodeCountry
Postion/Job Title:*
Title
E-mail*
example@example.com
Phone Number:

Area CodePhone Number
Cell Phone:

Area CodePhone Number
How did you hear about the RMGMA?*

ColleagueSocial MediaVMGMA ConferenceNational MGMAI attended a lunch meeting as a guest
If a colleague referred you, please let us know who it was!
Are you interested in serving on the Board of Directors?*

YesNoPlease send more information
MEMBERSHIP CATEGORY

Please select your membership category from the choices below. If you would prefer to pay your dues via check, your check may be made out to RMGMA and mailed to the RMGMA at 2821 Emerywood Parkway, Suite 200, Richmond, VA 23294.
How would you like to pay your membership dues?*

On-lineBy check
Active Member (Dues = $50) ----- Any individual employed in a management capacity by an entity providing healthcare services (including, but not limited to physician practices whether or not affiliated with an accredited graduate medical education or medical school program, federally qualified health centers or other community health centers providing physician or health care services, or ambulatory surgery centers, diagnostic imaging centers, home health agencies or similar providers)Affiliate Member (Dues = $150) ----- Any individual who is employed by, or an owner of, an entity providing products or services to health care providers (including, but not limited to, health care vendors or similar providers, insurers or physician network administrators). An affiliate member shall not have the right to vote or to serve as an elected director.Student Member (Dues = $25) ------- Any individual enrolled as a full-time student in a healthcare or business-related degree program at an accredited institution of higher learning (including, but not limited to, community colleges, technical colleges or universities or fellowship or post-graduate programs). A Student Affiliate Member shall not have the right to vote or to serve as a Director.Lifetime Member (Dues = $25) ----- Any individual who has been an Active Member in previous years and has fully retired from the field of health care management. A Lifetime Member shall not have the right to vote or serve as a Director.
For on-line payments, please select your membership category (current amount reflects dues plus a $10 convenience fee):*
prevnext( X )
ACTIVE MEMBER$60.00
Any individual employed in a management capacity by an entity providing healthcare services (including, but not limited to physician practices whether or not affiliated with an accredited graduate medical education or medical school program, federally qualified health centers or other community health centers providing physician or health care services, or ambulatory surgery centers, diagnostic imaging centers, home health agencies or similar providers).

AFFILIATE MEMBER$160.00
Any individual who is employed by, or an owner of, an entity providing products or services to health care providers (including, but not limited to, health care vendors or similar providers, insurers or physician network administrators). An affiliate member shall not have the right to vote or to serve as an elected director.

STUDENT MEMBER$35.00
Any individual enrolled as a full-time student in a healthcare or business-related degree program at an accredited institution of higher learning (including, but not limited to, community colleges, technical colleges or universities or fellowship or post-graduate programs). A Student Affiliate Member shall not have the right to vote or to serve as a Director.

LIFETIME MEMBER$35.00
Any individual who has been an Active Member in previous years and has fully retired from the field of health care management. A Lifetime Member shall not have the right to vote or serve as a Director.

Total $0.00

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First Name	Last Name
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Card Expiration

2023 Membership Application

MEMBERSHIP CATEGORY