AzSHRM Membership Application

The Arizona Society for Healthcare Risk Management (AzSHRM) is a non-profit professional organization dedicated to furthering and promoting the education, improvement and advancement of its members.

Membership is open to those employed in, interested in, or concerned with the profession of healthcare risk management.

Member Benefits:

  • Attend Quarterly Educational Programs free
  • AzSHRM’s quarterly newsletter – Full Disclosure
  • Networking with peers in the field of Healthcare Risk Management
  • Access to professional resources and reference materials
  • Stay current on industry trends in healthcare, legal, insurance and risk management

Become a Member – It’s easy as 1-2-3

 

 

Paying with PayPal? – Complete the application below and then click on the Submit button.

Paying by Check? – Click on the link below for a hard-copy application to mail in with your check.

AzSHRM – 2017-Individual-Membership-Application (hard-copy for mailing with your check)

 

Date:

Applicant Name:

Job Title:

Employer:

Employer Street Address:

City / State / Zip:

Work Phone:

Mobile Phone:

Email

Alternate Email:

Membership is for those who are a healthcare provider or employee of a healthcare facility with primary responsibility for risk management functions or a participant in the risk management function on behalf of a healthcare provider, e.g., insurers, consultants and defense counsel/staff.

PLEASE NOTE: By applying for membership in this organization you agree to have the information you provided above listed in a directory for the use of the organization’s members.

Are you a member of the American Society for Healthcare Risk Management (ASHRM)?
YesNo

Do you hold any of the following certifications? (check all that apply):
CPHRMFASHRM (Fellow)DFASHRM (Distinguished Fellow)

Organization type (check as many as apply):
Acute Care Corp/SystemPhysician OfficeExtended CareInsuranceAmbulatory CareConsulting FirmDefense Law FirmManaged Care OrganizationHome Health CareOther

Areas of Responsibility (check as many as apply):
A – Actuarial ServicesB – Insurance ManagementC – Insurance ProductsD – Employee BenefitsE – Claims Management – ProfessionalF – Claims Management – GeneralG – Claims Management – Workers CompH – Workers CompensationI – In-service EducationJ – Risk Management ConsultantK – Structured SettlementsL – Defense Legal ServicesM – Plaintiff Legal Services*N – Patient RelationsO - Analysis/TrendingP – Safety Officer - ChairpersonQ - Quality ManagementR – Contract ReviewS – Compliance OfficerT – Other

* Licensed Attorneys at Law who represent Plaintiffs in personal injury litigation are not eligible for membership

Please hit the Submit button to complete your application form:

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Pay your $100 annual dues via the PayPal button below.

 

Annual dues include all quarterly meetings with lunch.  Annual Membership dues are valid for the calendar year; January 1 through December 31.

“Non-members” are invited to attend our meetings for $60. You can register for a single meeting on our home page.

Please note, if you are a licensed Attorney and represent Plaintiffs in personal injury litigation, this meeting/membership is not available to you.


Membership Dues



 

Attend our quarterly meetings!