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WSHMMA membership
Member Questionnaire
Thank you for your interesting in joining WSHMMA [Western States Healthcare Materials Management Association]...
the Pacific Northwest chapter of AHRMM
...membership is FREE.
OK
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
2.
Are you employed by:
Acute Care Facility [hospital or IDN]
Non-Acute Facility [ASC or clinic or veterinary]
Vendor [mfg or distributor]
GPO
Other (please specify)
3.
Do you work or reside in the WSHMMA states [WA, OR, ID, MT, AK]?
Yes
No
If no, please specify
4.
Personnel Info:
Name
Company
Work Address
Work Address 2
City/Town
State/Province
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
Country
Email Address
Phone Number
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]
6.
Do you have any AHRMM certifications?
NO
CMRP
FAHRMM
7.
Are you on any AHRMM committees?
NO
Annual Conference Education
Chapter Relations
Education
Fellow Review
Issues and Legislative
Membership
Nominating
8.
Membership
NEW
Renewing/updating info
Current Progress,
0 of 8 answered
