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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