User Registration Form

July l, 2026 – June 30, 2027 Membership Application

Mission:The Rochester Regional Health Information Management Association promotes professional excellence and provides growth opportunities for its members and the region.

Please complete the following form.

Name*

First Last

AHIMA Number

Pick a Username*

Pick a Password*

Enter Password Confirm Password

Credentials (Check all that apply):*

Other Credentials*

Employer*

Job Title*

Are you a student enrolled in an CAHIIM Accredited HIA/HIT, Masters or Coding Program?*

Yes
No

Which program and educational institution?*

Name of Program*

Applicant Graduation Date:*

Preferred Address:*

Home
Work

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

*(Please provide a personal email, if possible. Work emails sometimes have firewalls that block our emails from reaching members.)

Are you a Dues Paying Member of:

NYHIMA*

Yes
No

AHIMA*

Yes
No

Another NYS CLA (local association)*

Yes
No

If yes, identify which CLA?*

Which CLA is your primary CLA?

RRHIMA
Other CLA

Which position(s) do you currently hold, or have you held in the past for RRHIMA or another AHIMA State or local component association? (Click all that apply)*

What BOD positions are you interested in? (Check all that apply)*

Select All
President
Membership Engagement
Communications
Education
Finance
Student Rep
None at this time

Which committees or activities might you be interested helping with as a volunteer? (Check all that apply).*

Membership Category (Select the appropriate status.)*

See Membership Categories page for category descriptions.

Total

$0.00

Select Payment Method*

If paying by check, please mail your check payable to RRHIMA to the address listed below. In the check’s memo field please write “Member Name; RRHIMA Dues 2026-2027.

Brandy Almekinder
RRHIMA Director of Finance
3905 Middle Sodus Rd
Lyons, NY 14489

For use by Membership/Database Project Manager:

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Specific method

RRHIMA BOARD Member

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Date of payment*

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Payment amount*

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Check Number*

Total

$0.00