Group Membership Registration - Arkansas Medical Society

The AMS “super group” program eliminates the hassle of collecting multiple statements and processing them individually. Clinics receive one itemized statement with all their physician membership information. Register your clinic or read more here…

Clinic Admin Name*
First Last
Clinic Admin Title*
Clinic Admin Email*
Billing Contact Name*
First Last
Billing Contact Title*
Billing Contact Email*
Clinic Name*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Fax
Please list all physicians in your clinic*
Copy and paste here, or send a list to Attn: Laura Haywood (lhaywood@arkmed.org or fax 501-224-6489)
Name
This field is for validation purposes and should be left unchanged.