MEMBERSHIP

Group Membership Registration

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…

"*" indicates required fields

Phone

This field is for validation purposes and should be left unchanged.

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 Katie Garcia kgarcia@arkmed.org.