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Membership Signup

Once you submit the form below, you will be prompted to pay using your Visa, MasterCard or American Express. Your credit card will be charged and your application will be pended until approval from National AMBA and verification of your AMBA membership is made. A confirmation email will be sent to you welcoming you to the chapter.

Thank you for supporting your Local Colorado Chapter

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Business Name
Email Address
AMBA Member #
AMBA Membership Type	Business MembershipIndividual Membership
Select One - Membership Status	Renewing Chapter MembershipNew Chapter Member
Full Name
Address
City
Zip
Business Phone
Mobile Phone
Fax
Website
Are you new to Medical Billing?	YESNO
Do you own a Medical Billing Company?	YESNO
Do you currently have clients?	YESNO
What specialty billing are you experienced in?
What Specialty would you like to learn about?
What Practice Management Software are you using?
What other practice management software's are you familiar with?
What expectations do you have from your chapter membership?
Please feel free to post any comments or concerns here
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Rocky Mountain AMBA
Copyright © 2006 All rights reserved.
Revised: 07/27/09

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