VAHRMM Membership Application Submit your individual membership online! “Annual membership dues are $35.00 per individual and are now included in conference registration fees.”

E-mail Address: * Choose one * - Vendor Representative - Healthcare Facility First Name * Last Name * Designation CMRP FAHRMM CPHM CRME CPM Other, see next question Other Designation Current Member of AHRMM Yes or No * If Yes, AHRMM Membership # Company/Healthcare Facility Name * Title Mailing Address * City * State * Zip Code * Work Phone Number & eXtension * Fax Number * Required