Attendee Registration for the 2023 WSHMMA event Conference Registration for Attendees Thank you for your interest in attending the 2023 WSHMMA Annual event [education and vendor fair] on Sept 13-15 at the Marriott Downtown Tacoma. OK Question Title * 1. Are you a involved in the materials functions of healthcare facilities, or are active in the healthcare materials supply chain, including manufacturers, vendors, distributors and group purchasing organizations? Yes No OK Question Title * 2. Are you employed by: Acute Care Facility [hospital or IDN] Non-Acute Facility [ASC or clinic or veterinary] Vendor [mfg or distributor or service provider] GPO Other (please specify) OK Question Title * 3. Do you work or reside in the WSHMMA states [WA, OR, ID, MT, AK]? Yes No If no, please specify OK Question Title * 4. Personnel Info: Name Employer Work Address Work Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address Phone Number OK Question Title * 5. Are you a member of AHRMM? Yes No If yes, please provide your AHRMM member number [this is on the weekly email sent out by AHRMM] OK Question Title * 6. Do you have any AHRMM certifications? NO CMRP FAHRMM OK Question Title * 7. Are you on any AHRMM committees? NO Annual Conference Education Chapter Relations Education Fellow Review Issues and Legislative Membership Nominating OK Question Title * 8. By selecting the payment option below i understand i am responsible for the $64 registration fee I will pay my $64 registration fee via the link at the end of this survey - $64 USD Please send me the address so a check can be mailed [check must be received prior to the event] - $0 USD If you have a coupon code then copy/paste this link to pay: https://buy.stripe.com/bIY5lN5XdfCq28E3ccit will take you to a new web page - $0 USD You will pay at the end of this survey. OK Question Title * 9. The vendor partners are very important to the WSHMMA board and membership thus after the event the vendor partners/sponsors will receive your email address [name, facility and email only]. Please approve this by selecting the choice below. YES - I appreciate the vendors who support WSHMMA, please share my email address with the vendor partners/sponsors NO - While i appreciate the vendors who support WSHMMA, please do NOT share my email address with the vendor partners/sponsors OK Question Title * 10. CMRP Review will be held on the first day - do you plan on attending? Yes No OK Question Title * 11. Additional Opportunity I would like to help with WSHMMA projects, please contact me I would like to help with the annual WSHMMA event, please contact me I would like more info about how to be on the board I'm not available to volunteer to help the WSHMMA board but I'm happy being a member OK Question Title * 12. Who can we thank for the referral? I've been coming to WSHMMA for years I read about it on the WSHMMA group page on LinkedIn WSHMMA website AHRMM website Referral by: Please enter referred by name: OK DONE