Become a Cardiovascular Administrator Member of the American College of Cardiology. One Membership. Many Benefits. ACC is Your Professional Home.

Similar documents
How to Apply: The Application Process

Become a Fellow/ Associate Fellow of the American College of Cardiology. One Membership. Many Benefits. ACC is Your Professional Home.

Shaping Tomorrow Together

Your Connection to Managed Care Pharmacy 50% mid-year discount. corporate. membership ACCESS VISIBILITY COST EFFECTIVENESS DEMONSTRATED COMMITMENT

Human Immunodeficiency Virus (HIV) Specialty Endorsement. Application. RICB HIV Specialty Endorsement Application June

IDA members are downtown champions and city builders PLAY DINE LIVE SHOP IDA MEMBERSHIP

Sponsor & Exhibitor Prospectus

International Downtown Association Membership Benefits

Member Benefit Guide Membership you can use. Education you can trust.

EMPOWERING WOMEN. EXPANDING AWARENESS. ERADICATING VIOLENCE.

Principals wear a lot of hats.

NYS Parent Teacher Association Strategic Alliance Working collaboratively to support New York s children, families and educators

NPA SPRING POLICY FORUM. April 1 2, H The Mayflower Hotel H Washington, DC CONFERENCE PROGRAM PACE NATIONAL ASSOCIATION

NATIONAL CERTIFICATE IN TOBACCO TREATMENT PRACTICE (NCTTP) TEST EXEMPTION OFFER APPLICATION VALID: OCTOBER 15, APRIL 15, 2018

NATIONAL CERTIFICATE IN TOBACCO TREATMENT PRACTICE (NCTTP) APPLICATION

Company Name: Physical Address: Mailing Address: 800#: FAX: Web: Date business was started: Description: (20 words or less)

Prevent. Educate. Empower.

Meeting Sponsorship Prospectus

American Academy of Sleep Medicine Membership

Intro to Science & Quality. Prepared for Emerging Faculty September 2014 Julia Chang, VP Science & Quality

Health Delivery and Technology in Today s DIABETES CARE

Recruited by: Information for Payment by Credit Card

ACC Cardio-Oncology Section Get Involved! Ana Barac, MD, PhD; Bonnie Ky, MD, MSCE; Monika Leja, MD

Alabama Certified Peer Specialist Training Application

OPERATOR MEMBERSHIP APPLICATION

2016 Pharmacist Re-Licensure Survey Instrument

INTERNATIONAL VISITING RESEARCH PROGRAM (IVRP) APPLICATION

FRONTLINE CARDIOLOGY. APRIL 21, 2018 College Park Marriott Hotel & Conference Center Hyattsville, MD COURSE DIRECTORS: COURSE CO-DIRECTOR:

Individual Membership Renewal

Scientist Survivor Program at the AACR Annual Meeting New Applicant Application

2019 Sponsorship Opportunities

The HearStrong Foundation s Sponsorship Levels and Benefits INSPIRATION DETERMINATION SHATTERING STIGMAS CHANGING LIVES

Denver, August 29, 2010

2015 AFRICA FORUM Legal Policy and Frameworks Surrounding the Energy and Extractive Industries in Africa with a Focus on East Africa

Dear Patron, Sinceramente, Cris Medina CEO Avenida Cesar E Chavez, Kansas City, MO t f

SPONSORSHIP OPPORTUNITIES

Omaha Sports Complex Omaha, Nebraska

OUTREACH FOR THE CGS 2015 ANNUAL MEETING AND BEYOND OPPORTUNITIES CGS ANNUAL MEETING December 2-5 Westin Seattle Seattle, Washington

Indianapolis, IN Saturday, June 25, 2011

Sponsorship & Vendor Partnership Opportunities

Striving for Equity in Hospice Palliative Care

Personal Information. Full Name: Address: Primary Phone: Yes No Provider Yes No. Alternate Phone: Yes No Provider Yes No

DISCOVER THE BENEFITS OF MEMBERSHIP

Partnership Opportunities

2018 Sponsorship Opportunities

Keep the Money in the Movement. Support the Movement & Expand your Exposure

Organizational Membership Program & Business Directory Listings

Fiscal Year 2019 (July 1, 2018 June 30, 2019) Membership Information & Application

PARTNERSHIP OPPORTUNITIES QUEEN CITY GOLF CLASSIC

2017 Donald H. Gemson Cancer Research & Public Policy Breakfast

Application form for an Annual Practising Certificate 2017/2018 Application form for updating Practising Status 2017/2018 (Annual Renewal)

Chapter Quality Network (CQN) Practice Improvement to Address Adolescent Substance Use Project Chapter Application

We invite you to join us on Thursday, May 17, 2018! Please see the following pages for further details on sponsorship and program ads.

2009 Northwest Chapter

NEW PATIENT HEALTH HISTORY

Sponsorship Opportunities

Conference Highlights

We are a network of successful REALTORS, advancing women as professionals and leaders in business, the industry and the communities we serve.

UPDATES IN NEPHROLOGY FOR THE PRIMARY CARE PROVIDER SATURDAY, MAY 5, 2018 THE INN AT ST. JOHN S, PLYMOUTH, MI

Heartland Kidney Network Network Patient Representative (NPR) Application

WHAT YOU CAN DO TO MAKE A DIFFERENCE

RESEARCH MEETING. Interest Group Meetings Sponsor Prospectus. arm.academyhealth.org. June 24, 2017 Hyatt Regency New Orleans ANNUAL

Relay For Life SPONSORSHIP OPPORTUNITIES

Visit aahpm.org to learn more about these programs. We appreciate your continued support and look forward to serving you in the coming year.

SPONSORSHIP OPPORTUNITIES

Membership Information and Application

ANNUAL CORPORATE PARTNER SPONSORSHIP OPPORTUNITIES

The Leading Global Provider of Fitness & Wellness Education

Sandia Plan Join our Sandia Plan today and enjoy on-the-spot savings from 20% to 60% on more than 250 dental procedures like exams, cleanings,

National Deaf-Blind Equipment Distribution Program Application

Retiree Dental Open Enrollment

Hoarding. Exhibitor, Sponsor, and Advertiser Brochure. Thursday - April 26, 2012 Friday - April 27, Westin San Francisco Airport Hotel

Cardiovascular Update for the Primary Care Provider. Friday, June 12, 2015 Seattle

NEDA WALK SPONSORSHIP PACKET

2017 Corporate Sponsorships

Associate Membership Application

2019 Sponsorship Program

Black & Red Sponsorship Opportunities

National Cardiovascular Data Registry

2017 Annual Luncheon Sponsorship Opportunities

Tennessee Building Officials Association MEMBERSHIP APPLICATION

Join Today -- Be a part of something BIG that will make a difference for Oroville!

Survey of Dentists in Delaware

CONNECT WITH GRADUATE SCHOOLS

Data Report 2016 Indiana Physician Licensure Survey

RAISE HOPE SPONSORSHIP OPPORTUNITIES MISSING CHILDREN SOCIETY OF CANADA THURSDAY MAY 25, :00PM - 9:00PM SUB ROSA, THE GUILD IN SUPPORT OF

January Dear Potential Exhibitor,

OPTIMAL CARE AND NEW THERAPIES FOR ADVANCED HEART DISEASE

Managing Older Patients With Lymphoma and Multiple Myeloma

WALK TO END LUPUS NOW 2015 SPONSORSHIP PROPOSAL

Echocardiography Update

SPONSORSHIP PROSPECTUS

Partnership Opportunities

Carrie Havens. Dear Candidate,

Partnership Program PARTNERSHIP COORDINATOR E. 104th Ave., Ste 800, PMB 302, Commerce City, CO

E & M Coding: Are You Leaving Money on the Exam Table?

Transcription:

Become a Cardiovascular Administrator Member of the American College of Cardiology Optimize your practice. Connect with physicians. One Membership. Many Benefits. ACC is Your Professional Home.

Connect With Physicians. Optimize Your Practice. Join the American College of Cardiology.

Managing a cardiology practice in a changing health care and economic environment can be challenging. That s why it s beneficial to have a partner that can help you stay up-to-date with key developments on issues in the field and succeed at the interface of practice management and quality improvement. Partner with an organization that unites all members of the cardiovascular team around one common goal: to improve the quality of cardiovascular care. Administrators in the CV Service Line and in the practice setting are invited to apply. Join us in our mission to transform cardiovascular care and improve heart health. Applications are accepted on a rolling basis. ACC.org/JoinCVAdmin

One Membership. Many Benefits. What Does Your Membership Unlock? The ACC is your professional home for tools and resources that support you in your efforts to provide high quality cardiovascular care to patients worldwide. As a member you can: Optimize Your Practice Access ACC.org for an array of CV Management tools such as 60+ webinars on practice changes, practice improvement modules, quality improvement initiatives, health IT tools, the PINNACLE Registry TM and more. Access Guidelines Access Guidelines, Appropriate Use Criteria and Consensus Documents, both online at ACC.org and through the Guidelines App. Keep Your Entire Practice Informed Use ACC s CardioSource Plus, a facility-wide subscription, to access virtually all of ACC s online educational resources. Access board prep activities, self-assessment questions, hundreds of hours of CME credit, heart songs, highlights for ACC s Annual Scientific Session and more! Gain an Advocate for Your Interests With the power of a collective voice, the ACC advocates on your behalf of your interests, to regulatory and certification bodies, to payers and to policymakers at the federal and state levels. Receive Up-to-Date Advocacy News Stay current on important advocacy, reimbursement and policy issues and coding updates with free online and email resources. Members will receive a bi-monthly e-newsletter focused on practice management and regular e-alerts on how to evolve with the latest policy changes. Stay Informed Read about the latest clinical developments in FIVE Journals of the American College of Cardiology also available on ipad including JACC, JACC: Imaging, JACC: Interventions, JACC: Heart Failure and JACC: Clinical Electrophysiology. Advance Your Career Access tools and resources to advance your career and save you time and money on staff recruitment with the ACC Cardiology Careers website, loaded with thousands of jobs for cardiovascular professionals. Advance Your Specialty Network and advance the priorities of your specialty and/or interest areas in one of over 16 Member Sections, which serve as communities for driving strategy and initiative development for communities within the College. Join the ACC s Section focused on Cardiovascular Management and influence College and national issues related to the management and operation of CV enterprise. Build Your Professional Network Connect and collaborate with nearly 50,000 cardiovascular professionals worldwide. Network and learn at the local level with one of ACC s over 80 local Chapters. And gain leadership experience and recognition by participation on Councils, Committees and Work Groups Access Mobile Applications Get support to treat patients and manage patients on-the-go with mobile applications, including the NEW Guidelines App, ASCVD Risk Estimator, CardioSmart Explorer and AnticoagEvaluator.

How to Apply: The Application Process To apply, submit your application packet consisting of: 1. Completed Application Form 2. Payment of Annual Dues and Nonrefundable Application Fee. Annual Dues and Fees Payment must be enclosed with application for processing. CV Administrator Annual Dues $250 Application Fee $25 Mail your entire packet to: American College of Cardiology Membership Services 2400 N Street, NW Washington, DC 20037 P: (202) 375-6000, ext. 5439 (800) 253-4636, ext. 5439 Membership@acc.org Total Payment to Accompany Application $275

Connect With Physicians. Optimize Your Practice. Join the American College of Cardiology

CARDIOVASCULAR ADMINISTRATOR APPLICATION Complete the application in its entirety. Please print or type ( See CV is not acceptable) I am applying as a: q Practice Administrator q Member of the Cardiovascular Service Line PERSONAL DATA Birth Date (Month/Day/Year) Gender q M q F NPI # (Optional, and if applicable) Prefix First Name Middle Name Last Name Degrees Suffix Race/Ethnicity q American Indian or Alaska Native q Black or African American q White q Hispanic or Latino q Asian q Other q Native Hawaiian or Other Pacific Islander MAILING ADDRESS Please select preferred mailing address for ACC mail: q Practice/Institution q Home/Personal Practice/Institution Contact Information Practice/Institution Name Department Name Practice/Institution Street Address City State/Province Postal Code Country Phone Home/Personal Contact Information ACC Practice ID# (if known) Home/Personal Street Address City State/Province Postal Code Country Phone Fax Email Address Please select preferred email address for ACC Communication q Practice/Institution q Home/Personal Business Email Personal Email PAYMENT Payment must be included with application to ensure processing New Members: Include US $275 with the application. q MasterCard q VISA q American Express q Discover ACC does not accept any other credit cards Card # CSC # (Required) 3-digit number on back of card or 4-digit on front of Amex Exp.Date q Check payable in US funds drawn on a US bank. Check # Amount WORK SETTING & STRUCTURE Which of the following best describes your primary work setting? Choose one. q Cardiovascular Group q Government Hospital or Agency-Military q Government Hospital or Agency-Other q Government Hospital or Agency-Veterans Affairs q Industry (pharma, device) q Insurance Company (HMO, PPO, IPA) q Medical School/University q Multi-Specialty Group q Non-governmental Hospital q Solo Practice What is the ownership structure of your practice? (Choose one) q Government Owned q Hospital Owned q Insurance Company Owned q Medical School/University Owned q Physician Owned q Not Sure q Other, please specify 1 of 2

CARDIOVASCULAR ADMINISTRATOR APPLICATION CME/CE INTEREST AREAS Please check off your top three areas of interest in cardiovascular medicine. q Administration q Adult Cardiology q Adult Congenital Cardiology q Anesthesiology q Arrhythmias and Devices q Cardiac Rehab q Cardiothoracic Surgery q Congenital Cardiac Surgery q Critical Care Medicine q Echocardiography q Electrophysiology q Emergency Medicine q Endocrinology q Family Practice q General Cardiology q Geriatrics/Aging and CV Disease q Heath Policy q Heart Failure/Transplant q Hypertension q Internal Medicine q Interventional Cardiology q Invasive Cardiology q Lipids Clinic q MR/CT Cardiology q Nephrology q Nuclear Cardiology q Nuclear Medicine q Pathology q Pediatric Cardiology q Pediatric Interventional Cardiology q Pediatrics/Neonatal q Pharmacology q Physical Medicine q Physiology q Preventive Cardiology q Public Health q Pulmonary Disease q Radiology q Research q Sports & Exercise Cardiology q Thoracic Surgery q Transcatheter Valve Therapy q Vascular & Interventional Radiology q Vascular Medicine q Vascular Surgery q Other PRACTICE SERVICES PROVIDED Please check all that apply. ADULT CARDIOLOGY SERVICES q Cardiac Diagnostic Catheterization q Cardiac Interventional Catheterization q Cardiac CT q Cardiac MR q Cardiothoracic Surgery q Echocardiography q Electrophysiology q General Adult Cardiology q Pulmonary Hypertension q Cardiac Rehabilitation q Cardiomyopathy and Heart Failure q Cardiovascular Genetics q Cardiac Critical Care q Emergency Medicine q Exercise Testing and Physiology q Heart Transplant Program q Endocrinology q Geriatrics q Hypertension Management q Lipid Clinic q Nephrology q Nuclear Cardiology q Pacemaker Clinic q Preventive Cardiology q Vascular Medicine q Other PEDIATRIC CARDIOLOGY SERVICES q Cardiac Diagnostic Catheterization q Cardiac Interventional Catheterization q Cardiac CT q Cardiac MR q Cardiothoracic Surgery q Echocardiography q Electrophysiology q General Pediatric Cardiology q Pulmonary Hypertension q Cardiac Rehabilitation q Cardiomyopathy and Heart Failure q Cardiovascular Genetics q Cardiac Critical Care q Emergency Medicine q Exercise Testing and Physiology q Heart Transplant Program q Fetal Medicine q Nuclear Cardiology q Pacemaker Clinic q Preventive Cardiology q Other ADULT CONGENITAL HEART DISEASE SERVICES q Cardiac Diagnostic Catheterization q Cardiac Interventional Catheterization q Cardiac CT q Cardiac MR q Cardiothoracic Surgery q Echocardiography q Electrophysiology q General Adult Congenital Cardiology q Pulmonary Hypertension q Other How did you hear about membership? CONGRESS17 q Email q Direct Mail q A current member: q Print Ad q Web q Other Promo Code: Please sign and date your application Signature of Applicant Date Check before you submit! Ensure your application is completed in full and all required elements listed under How to Apply are included with your application. American College of Cardiology ATTN: Member Services 2400 N Street, NW Washington, DC 20037 Phone: (202) 375-6000, ext. 5439 (800) 253-4636, ext. 5439 E-mail: membership@acc.org 2 of 2 2017, American College of Cardiology Foundation F17687