Health Information Management Association of New York City (HIMANYC) 2008-2009 Membership (7/1/2008 - 6/30/2009)
Code
Membership Form
Bold = Required Field
Select the membership code from the table above.
Select One 01 02 03 04 05 06 07 08
Newsletters will be distributed by e-mail. If you do not have an email address, type "none".
Do you want your contact information shared in the membership directory?
Yes, you can share my information. No, do not share my information.
Two names are allowed for corporate members. Enter the name, title, and email address of the second member.
I have reviewed and acknowledge acceptance of the terms and conditions which includes the insufficient check funds policy and the credit card terms and conditions.
* Select One Yes, I agree to the terms and conditions
Payment options include: Credit card and check
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