This form is designed to be filled in online, printed and mailed.
Membership is open to Professionals in the following fields:
  • Quality management
  • Risk management
  • Case management
  • Utilization management
  • Medical records
  • Health Information management
  • Medical staff management
  • Discharge planning
  • Data abstracting and analysis
  • Infection control
Benefits of Membership:
  • Educational Conferences
  • Quarterly Newsletter
  • Networking Opportunities with Healthcare Quality Professionals
  • Affiliation with the National Association for Healthcare Quality (NAHQ)
  • Affiliation with Local Chapters
  • Assistance with Preparation for CPHQ Examination
  • Leadership Opportunities
  • Speakers Bureau
Active Membership in MoAHQ
Name
Job Title
Organization
Address
City
State
Zip
Business Phone
 Business Fax
 Business Email
  Home Contact Information
Address
City
State
Zip
Phone
Fax
Email
Contact Preference Home Work
Date
Signature
Payment Amount $25
Referral Person
(if applicable)
Licensure/Certification
Held
  Are you currently a member of the National Association for Healthcare Quality?  Yes No
  Are you a CPHQ? Yes No
  Would you be interested in serving on a committee? Yes No

I have read and meet the membership requirements as stated. I have enclosed a $25 check for annual dues made payable to: MoAHQ of MHA Center for Education. ANNUAL DUES ARE PAYABLE EACH JANUARY 1.

Please print and mail to:

MHA Center for Education
Missouri Association for Healthcare Quality
PO Box 60
Jefferson City, MO 65102-0060

Membership dues are not deductible as charitable contributions for federal income tax purposes.