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ACMQ Individual Membership

The ACMQ membership year is based on the calendar year, January 1-December 31. ACMQ does not pro-rate membership; fees are due annually, or upon joining. Membership of an applicant joining in the last quarter of the year (October-December) automatically extends through the end of the following membership year; e.g. joining on Nov. 1, 2015, will benefit membership to Dec. 31, 2016).

  • Affiliate: $200; any health care professional with less than a master’s degree; examples: RT, RN, RT(T)
  • Member: $330; health care professional with a master’s degree or higher; examples: MD, DO, PhD, Pharm D, MBA, MSN, MPH, MNS-NP, MS
  • Student: $25; graduate/medical student enrolled full-time (one-time fee, expires upon graduation)
  • Resident/Trainee/Fellow: $40; enrolled full-time (one-time fee, expires upon residency/fellowship completion)

Select Member Type: *
Amount:
Select Special Interest Groups:
First Name * M.I. Last/Family Name * Highest Academic Degree *
Birth Date (mm/dd/yyyy) mm/dd/yyyy
Primary Phone *
Cell/mobile
Email *
Job Title
Affiliation
Home Business *
Address1: *
Address2:
City/State/Post Code: * *
Province (non US/Canada):
Country:
Promotion Code? Enter it here: 
How did you hear about ACMQ?: 
You may select up to 5 options.
Referring Member (name): 

I give permission to ACMQ to contact me using the contact details and email I have provided in my profile and to include me in ACMQ's email list to receive information about ACMQ and ACMQ events. I also give permission to ACMQ to share with SAGE, the publishers of ACMQ's "Journal of Medical Quality", my mailing address and email in order for me to receive my copy of the journal by mail and to enable my online access to the journal.
Yes No (you will be removed from all ACMQ communications except dues notices)

Include my contact details in the membership directory of the ACMQ website so that other ACMQ members can find me (the directory is not open to the public):
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I am currently certified in medical quality (CMQ) by ABMQ: 
Certified in specialty?: 
Year of Specialty Certification: 
Check if you are a current AMA member: 
I currently hold a master's or higher degree: 
I am studying to complete: 
Medical/master's-level degree grad date (MM/DD/YYY):  *
Expected Date of Fellowship Completion (MM/DD/YYYY): 
Expected Date of Residency Completion (MM/DD/YYYY):  *
Your current academic institution: 
* = Required Field