Join – Western North Carolina Medical Managers Association

Applicant's Name*

First Last

Applicant's Title*

Company Name*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Specialty

Company Telephone Number*

Mobile Phone Number

Fax Number

Email*

Company Website*

Number of Physicians

Number of Employees

Are you a member of the Medical Group Management Association (MGMA)?*

Yes
No

What is your status with the American College of Medical Practice Executives?*

Fellow
Certified
Nominee
None

Are you a member of NC MGM?*

Yes
No

What Electronic Medical Records (EMR) software does your company use?

Please list your certifications

Membership Type:*

Active membership – Works for one or more licensed Doctors of Medicine - $125/year
Allied membership – Works in an outside support role for a license Doctor of Medicine. Not eligible to hold office with WNC MMA. May attend all meetings. - $200/year

Both membership types include entry to WNC MMA Network and Learn luncheons each January, March, May, July, September and November. Membership also includes periodic social events and conferences.

After you complete this form, please select "Submit." We will follow up with you to complete the membership process.

Email

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