Membership Application

January - December 2008

Annual Membership Dues are $50.00. Please make checks payable to Nevada Association Medical Staff Services. Complete the form below and mail application and fee a $50.00 annual membership fee to: TREASURER Janice Danduono Credentialing Specialist Sunrise Market CVO 3150 North Tenaya Way, Ste. 405 Las Vegas, NV 89128 janice.danduono@hcahealthcare.com Phone: 702.562.5719 Fax: 866.244.2647

Name (Last, First ):
Certification (if applicable):
Employer/Title:
Business Address:
Zip/Postal Code:
Business Phone:
Business Fax:
Business Email:
Home Address:
Home Zip/Postal Code :
Home Phone:
Home Email:
*Comments:*	Place Comments in here!

The Nevada Association Medical Staff Services (NvAMSS) recruits its own membership and dues independently from the National Association of Medical Staff Services (NAMSS). You cant contact NAMSS through our link. nvamss edit mini21.jpg