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WSHMMA event scholarship
Member Questions
Thank you for your interesting in an event scholarship to attend the WSHMMA annual educational and networking event.
OK
1.
Type of Scholarship you are applying for:
Event registration to be covered only
2 night stay in a hotel only
Full Scholarship [2 nights stay at the host hotel and event registration]
What City will you be traveling from:
2.
Are you a involved in a supply chain function of healthcare facilities, or are active in the healthcare materials supply chain, including manufacturers, vendors, distributors and group purchasing organizations?
Yes
No
3.
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)
4.
Do you work or reside in the WSHMMA states [WA, OR, ID, MT, AK]?
Yes
No
If no, please specify
5.
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
6.
Are you a current member of WSHMMA?
Yes
No
7.
Are you a first-time Conference attendee?
Yes
No
8.
Do you belong to any other AHRMM chapters?
Yes
No
if yes, please let us know which one(s):
9.
Are you a current member of AHRMM?
Yes
No
Please list your AHRMM member number:
10.
Do you have any AHRMM certifications?
NO
CMRP
FAHRMM
11.
Are you on any AHRMM committees?
NO
Annual Conference Education
Chapter Relations
Education
Fellow Review
Issues and Legislative
Membership
Nominating
12.
Why do you require financial assistance to attend the annual conference? (Attach a letter from your manager or supervisor that establishes financial need or if you are between jobs, provide an explanation of financial need.)
Current Progress,
0 of 12 answered
