Online Membership Application

Email Address:
Password: (login password)
Member Type:

NFMGMA Membership Categories

Active - An active member shall be involved in the administration or management of a medical practice engaged in the practice of medicine as a legal entity.
Student - A student is categorized by pursuing health studies on a full time basis
Affiliate - An affiliate member is an individual or company who supplies products or service to medical group practices. Affiliate members will be reviewed before being allowed to complete the application process.(Only one person per company will be allowed to attend each meeting)
First Name:
Last Name:
Title:
Practice/Organization:
Affiliated:
If affiliated with another organization through ownership or legal affiliation, please indicate the name of the organization.
Business Address:
Business Address 2:
City:
State:
Zip:
Phone:
Fax:
How did you hear about NFMGMA:
Referring member or organization:

Total number of practicing physicians in your facility:

Physicians:
Physicians Assistants:
Nurse Practitioners:
Nurse-Midwives:
Physical Therapists:
Audiologists:
Other:

Please indicate ancillary services provided by your facility:

Lab:
Ultrasound:
Nuclear Testing:
X-Ray:
Ambulatory Surgery:
Physical Rehabilitation:
Nutrition/Wellness:
Home Health Care:
   
Please list any topics you would like to have a guest speaker present:
Are there any MGMA benefits you'd like to learn more about?
Provide name/contact information for anyone who would benefit from becoming a member?
For potential Affiliate Members, please describe in detail the services your company can provide and what percentage of your business is devoted to medical practices:

Affiliate's Industry:
   
For members, your the next step is payment of your yearly dues. You must pay to complete your application, so have your credit card ready.
For affiliate members, your application must be approved. Approval depends on the completeness of your application.