Wisconsin Society of
Medical Assistants

Are you a AAMA member? __________ ( FYI: membership to AAMA includes your membership to WSMA & your local chapter, it is a tri-level membership)

Are you a Certified Medical Assistant®? ___________What year did you certify/recertify? ______________

Are you a non-member? ___________

Are you a practicing medical assistant? ____________
if so, what area do you work in? ____________________________________________________________

Are you a retired medical assistant? _________________________________________________________

Are you an Medical Assisting Educator? _____________________ At what school? ____________________
________________________________________________________________________________________

If you are not a member, would you be interested in becoming a member of AAMA/WSMA? _____________
Would you like someone to contact you regarding membership? ___________________________________
If yes, where can you be reached & what time is best to contact you? ______________________________

What is your choice for a start time for education sessions? ____________________

What is your choice for a end time for education sessions? _____________________

How many ceu's would you like offered at education seminars? __________________
(one ceu is one hour in length)

List topics you would like to hear? _____________________________________________________________
_________________________________________________________________________________________

Would you like to recommend a speaker that would be interested in speaking at a WSMA education function? (please provide name, location & how can they be contacted)____________________________________ _________________________________________________________________________________________

How many AAMA/WSMA education sessions do you attend in a year? ________________________________

Would you like to attend more in a year? _______________________________________________________

What is the reason you do not attend more? ____________________________________________________

Would you be interested in joining a WSMA committee? ___________________________________________

Would you like someone to contact you regarding committees? _______________ If yes, where & when are you able to be reached? _____________________________________________________________________

Is there anything you feel that the Wisconsin Society of Medical Assistants should be doing for you? _________________________________________________________________________________________
_________________________________________________________________________________________