Better Management Improves Patient Care

		Join the AACD Membership Secure Online Payment Form NOTE: The information you submit via this online form is being transmitted SECURELY to our payment server, using high-grade encryption.  <%=Request("joe")%>      YOUR INFORMATION: First Name:     MI:     Last Name:  Street Address (Preferred Mailing Address):  Street Address - Continued:  City:  State:  ZIP:  E-mail Address:  Birth Date:  Fax number:  Telephone number:      PROFESSIONAL  INFORMATION: Present Position:  Select One Staff Anesthesiologist Nurse Manager Administrator Surgeon OR Administrator Other    Medical Director: Select One      Yes No Anesthesiologist: Select One      Yes No             Additional Position:      Academic  Degree:  Select One      MD DO RN PhD MBA CRNA MPH Other          Another Academic  Degree:  Type of Practice:  Private   Government  University    Other: Board Certification, Specialty:    Year: