MINK - Missouri, Iowa, Nebraska, & Kansas Staff Physician Recruiters Association

Membership Request Form (Fields Required Are Marked With *)

Name*
Title*
Hospital/Group/System*
Email*
Web
Phone*
Mobile Phone
Fax*
Address*
City*
State and Zip*
Service Area of Your Organization
Description of Your Organization
Residency Programs in Your Organization
What percent of time is devoted to physician recruitment?
How many years of experience do you have?
Highest Educational Degree
Is a fee charged for recruited physicians? If yes, please explain structure.

Attention: If submit is hit with required fields left blank, all information will be deleted.

Note: Once you have submitted the membership form, make sure to mail in your membership dues along with the MINK Membership Invoice.