Personal Information

First Name*

Middle Name

Last Name*

Email Address*

Postal Address

Country*

Place of Birth

Date of Birth*

Professional Information

Current Employer*

Employer Address

Employer Website*

Designation*

Work Phone*

Cell Phone

Academic Information

Highest Qualification*

Year of Passing*

Total Industry Experience*

Industrial Experience & Engagements

Speaking Engagements(if any)

Yes

Details

I am willing to apply for a representative position in the Advisory Group of American Hospital & Healthcare Management.

Declaration:

I declare that the above information is true to my knowledge and belief. I understand that in the event of my information being untrue or incorrect at any stage, my membership/appointment shall be liable to cancellation/termination without notice.

Disclaimer:

1. Neither the signee nor AmHHM is financially liable to one another for any commitments, services, nor consultations provided.

2. AmHHM, along with its internal editorial team, reserves the right to decide and finalize articles and materials for publication.

3. AmHHM is not obligated to provide marketing, sales, or promotional services in exchange for any business advisory, consultation, or articles contributed by an external source.

Application to Serve on the Advisory Board