I hereby make application for membership in the Arkansas Foundation for Medical Care (AFMC) and agree, if approved as a member, to support its mission to promote excellence in healthcare through evaluation and education. A hard copy of the Bylaws is available upon request.

If desired, you may print it out this page and mail it to:

Arkansas Foundation for Medical Care
PO Box 180001
Fort Smith, AR 72918-0001
ATTN: Patricia Williams

If you are unsure of your membership status, contact Patricia Williams 479-573-7612, fax 479-649-8180, pwilliams@afmc.org.

* indicates a required field *First Name *Last Name        *Office Address *City *State   *Zip     *Phone     Ext    E-Mail Adress   ReEnter E-Mail Address for Verification   * License# * Specialty *Active Hospital Affiliation(s) I am interested in being a physician advisor/reviewer. Yes   No     I am interested in participating in an AFMC committee Yes   No