NV HIMSS Chapter Membership Interest Form
Share your contact and professional details to express interest in joining the Nevada HIMSS chapter.
Name
*
First Name
Last Name
Primary Email Address
*
example@example.com
Secondary Email (work email address)
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Job Title / Position
*
Organization / Employer
*
City
*
State
*
Please Select
Nevada
Alabama
Alaska
Arizona
California
Colorado
Idaho
Oregon
Utah
Washington
Other
Professional Credentials / Certifications (e.g. RN, CPHIMS, FHIMSS)
Years of Experience in Health IT
Please Select
Less than 1 year
1-3 years
4-7 years
8-15 years
15+ years
Primary Area of Interest
Clinical Informatics
Health IT Leadership
Cybersecurity
AI & Emerging Technology
Interoperability & HIE
Nursing Informatics
Student/Academic
Other
How did you hear about NV HIMSS?
Please Select
HIMSS National
Colleague/Referral
Social Media
Event/Conference
Email
Other
Are you currently a HIMSS National member?
*
Yes
No
Not sure
I am interested in:
Chapter membership
Volunteering/Board participation
Attending chapter events
Speaking opportunities
Sponsorship opportunities
Additional Comments
Submit
Should be Empty: