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MoHIMA Affiliation Funding Verification

Upon Regional Association affiliation approval by the MoHIMA Board, funds will be provided once annually to assist with the needs of Regional membership. The amount will be determined by the MoHIMA Board and will be assessed when setting the budget for the next operating year.

1) Complete the information below.
2) Read, sign and email the MoHIMA Support Agreement to
3) Send current regional bylaws to

Upon MoHIMA Board approval, funds will be distributed within 2 months of receipt of these required documents.

(The information below should pertain to the usage of MoHIMA affiliation funding received during the prior 12-month period.)
4. Were CEUs awarded? *This question is required.