AzHAM Annual Conference Registration

Friday, July 27, 2018

Hosted by: Honor Health

Brady Conference Center

9003 East Shea Boulevard, Scottsdale, AZ 85260

Membership Form / Annual Renewal Form

 

 

Check all that Apply

Name

Title

Email

Phone #

Membership

Conf Only

New

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Organization Name:                                                                                                                                                                

 

Organization Address:                                                                                                                                                           

 

Referred by                                                                                                                                                                              

                                        (AZHAM Member / Facility Contact)

 

Conference & Annual Membership Fee   $35.00   

 


                                           

 

                                

 

Payment can be made over the phone or mail payment. Make checks payable to Arizona Assoc. of Healthcare Access Management.  

 

To:        AzHAM                                                        

Attn: Joy Everson – Treasurer                          Federal Tax Id = 86-0720323

P.O. Box 12485                                                   E-Mail:    Everson.Joy@mayo.edu

Scottsdale, AZ 85267

                                                   

Gold Sponsor                              Silver Sponsors                           Bronze Sponsor    

 

 

 

 

 

 

 

 

Text Box: Please RSVP by July 15, 2018