EMPAA State Medicaid Employed Alumni ListServ
Please complete this form if you are a EMPAA State Medicaid Employed Alumni. All EMPAA alumni statuses will be verified. Restrictions/Exclusions apply. This form is for people previously employed by a state Medicaid.

If you are WMPAA or SAMPA State Medicaid Alumni, please fill out the appropriate ListServ on the WMPAA.net Home Page. Information will be forwarded to respective associations.


This is NOT a registration Form.
New Member or Updating Contact Information? *
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
EMPAA State(s) you used to work for (list all states)? *
Your answer
Job Title(s)? *
Your answer
Year(s) active with State(s) (i.e. MA 2000-2005, DE 1998-1999, etc.) *
Your answer
Current Employer *
Your answer
Current Job Title *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy