MIDDLE TENNESSEE CHAPTER
ASSOCIATION FOR HEALTHCARE DOCUMENTATION INTEGRITY (AHDI)
Middle Tennesse Chapter of AHDI Membership Application (Membership is from July to July of each year)
Today's Date:
Check All That Apply:
New Member: Student: Practitioner: Renewing Member:
Name: Address:
City: State: Zip: Birth Date (mo./day):
Telephone: Email address:
AAMT Membership Number (if applicable): Certification (CMT, FAAMT, etc. if applicable):
DUES: $20.00 per year MAKE CHECK OR MONEY ODER PAYABLE TO: MIDDLE TENNESSEE CHAPTER OF AAMT
ALL DUES ARE REMITTED BY JULY 1ST OF EACH YEAR. IF YOU JOIN BETWEEN JANUARY AND JULY, PAY ONE-HALF OF THE AMOUNT DUE. IF YOU JOIN BETWEEN MAY AND JULY, YOUR $20 DUES WILL BE CURRENT FOR THE REST OF THIS YEAR AND THE FOLLOWING YEAR.
Print out this form and contact Diane Gilmore, CMT by E-mail at d394mg@hughes.net for information on where to send your check or money order.
Thank you for joining our chapter! We look foward to meeting you!
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