Member Application

* First

* Last

* Certification(s) CPCS, CPMSM, etc.

Title

* Organization

* Address

* City

* State

* Zip

* Phone

Fax

* Email

* Are you new to the medical staff/credentialing field?

* Is this your first time joining WAMSS?

* What are your primary work responsibilities? i.e., credentialing verification, CME, etc.

If you are not currently CPMSM or CPCS certified, are you interested in becoming certified?

* Does your current position require you to be knowledgeable in the following standards?

* Please provide the URL Address used to produce Hospital Affiliation Verification letters of providers credentialed with your Organization If None, please write "N/A". This information is being requested to create a resource available to WAMSS Members.

If referred by an active WAMSS Member, please include member's Full Name

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Member Application

PLEASE NOTE: If paying by check, you will not have access to the "MEMBER AREA" until payment has been received and inputted into our system.