US National Standards Development Application Form

The Healthcare Standards Institute (HSI) is accredited by American National Standards Institute (ANSI) as an Accredited Standards Developer (ASD).

Through your participation in this group, you may contribute to the creation of US standards. HSI also a member of the TC 304 US Technical Advisory Group that contributes to International ISO standards for Healthcare Organization Management. Therefore, through your association with HSI you may also participate at the international level if desired.

Please Note: Use this form if you will be an individual member representing yourself.
If you will be representing a company, organization, or government agency please use this form instead.

Name

First Last

Phone

Title

Address

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

Please list your experience with standards development (if applicable)

If your organization has relationships that are or could be perceived as conflicts of interest with any other organization, or any standards projects under development, please identify the organization(s) and briefly describe the nature of the relationship or potential conflict of interest (Such relationships do not necessarily disqualify an applicant from a voting membership).

Conflict of Interest

I am not aware of any conflict of interest

Potential conflicts of interest

Please Explain

Please provide any additional information or statements to be considered while reviewing your application for membership.

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