AMPAA State Medicaid Employed Alumni ListServ
PLEASE READ BEFORE PROCEEDING!!!

You must have been EMPLOYED BY A STATE MEDICAID to complete this form. (EMPAA/WMPAA/SAMPA)  

Alumni members must have a previous tenure of not less than five (5) years as an active member (per the bylaws).

Entries made by INDUSTRY people who have NEVER BEEN EMPLOYED BY A STATE MEDICAID WILL BE DELETED without notice.

Former AMPAA state members currently working for an organization who contracts with Medicaid cannot attend AMPAA as Alumni.

This is NOT a registration Form.
Sign in to Google to save your progress. Learn more
New Member or Updating Contact Information? *
First Name *
Last Name *
Personal Email Address (don't use work) *
STATE MEDICAID(S) you used to work for (list all states)? *
Job Title(s) at your STATE MEDICAID job? *
Year(s) active with State MEDICAID(S) (i.e. ND 2000-2005, SD 1998-2010, etc.) *
Current Employer *
Current Job Title *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms