Membership Registration - Minnesota Association of Medical Staff Services

Membership Year is JULY 1 – JUNE 30
Dues for this year are $50.00

To pay by check, print an application form and mail to:

Laurie Pechnovnik
Mercy Hospital – Unity Campus
550 Osborne Road NE, MR 52400
Fridley, MN 55432-2718

Complete the form below to pay online with PayPal

Applying for*
- Initial Membership
- Renewal of Membership
- Transfer of Membership
Please note a 4% processing fee will be added to all online payments to help offset PayPal fees incurred.
Name*
First Last
Credentials*
Use existing member information?
- If after reviewing the MAMSS roster on the website, there are no changes to your contact information, please check here
Phone
Ext.
Fax
Email of Member*
Employer*
Job Title*
Referred by:
If you referred by a member of MAMSS, please enter their name here.
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Birthday
MM slash DD slash YYYY
Type of health care entity employed in
Branch
Type
Are you a member of NAMSS?*
The Minnesota Association Medical Staff Services (MAMSS) recruits and processes its own membership and dues independently from the National Association Medical Staff Services (NAMSS). While NAMSS membership is not a condition of MAMSS membership, it has its own benefits.
- Yes
- No
Digital Signature*
By signing below, I hereby acknowledge that I have reviewed and agree to abide by the MAMSS Bylaws and Policy and Procedures.
Untitled
Total
$0.00

Referral Program:

Refer a friend, co-worker or supervisor and receive a $10 Gift Card to Target, Amazon or BestBuy for EACH new member Referral.