Formulario Nuevos Socios

2025 New Member Registration Form

Requirements for Completing the Form

In this registration form for the Mexican Association for Quality in Health and Patient Safety (AMEXCASEP A.C.), you will be asked to provide personal and professional information for the purpose of enrolling in the Association.

Before completing this form, please have your résumé and proof of membership payment ready.

Payments should be made to the following bank account:

Banco Santander

Account Name: Asociación Mexicana por la Calidad en Salud y Seguridad del Paciente AMEXCASEP

Account Number: 65510537578 65510537578

CLABE: 014320655105375780 014320655105375780

Active Member: $3,000 MXN

Training Member: $1,500 MXN

Full Name *

Date of Birth *

Phone number *0 / 10

Gender *FemaleMaleI prefer not to say

Email *

City *

State/Province *

Postal Code *

Country *

How did you find out about AMEXCASEP? *Invitation from a partnerSocial networksAnother

If you joined through an invitation from a current member, please write their name here:

ACADEMIC INFORMATION

For AMEXCASEP, it is essential to understand the educational background of its members, both to uphold its principles and to provide continuous development opportunities for its members. Below, you will find various requests for information regarding your academic background.

Professional training *

Do you have a speciality? *YesNo

If you hold a specialty degree, could you specify which one?

Last degree of studies *

Do you have training in Health Quality? For example, courses, diplomas, master’s degrees, PhDs, etc. *YesNo

If you answered yes to the previous question, please list up to three of the most significant training programs in health quality. Be sure to specify where they were conducted and the time period, in chronological order from the most recent to the oldest.Example: 1. Master’s in Quality Management and Patient Safety in Healthcare Services at the University Center for Health Sciences, 2022-2024 2. Quality Improvement Cycles Course, National Institute of Public Health, August 2020 3. Quality Management Training Course, Quality Coordination of the Jalisco Health Department, January-March 2020

Have you participated in publications in scientific journals, editorials, book chapters, or scientific dissemination materials related to health quality? *YesNo

If you answered yes to the previous question, please list up to two of your most significant publications and provide the access link if available. List them in chronological order, from the most recent to the oldest.Example: 1. Application of the WHO Multimodal Strategy Self-Assessment Questionnaire to Improve Hand Hygiene Practices in a Tertiary Hospital, https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1578-25492021000400355 2. Implementation of a Multimodal Hand Hygiene Strategy in a Pediatric Hospital, https://revistas.uv.cl/index.php/Benessere/article/view/1396

PROFESSIONAL INFORMATION

For AMEXCASEP, understanding the professional background of its members is crucial to fulfilling its principles and providing continuous development and training opportunities. Below, you will find various requests for information regarding your professional background.

Type of Institution where you currently work *

Institution where you work *

What is your current job title? *Please list your position, department, coordination, or equivalent, the institution where you work, and how long you have been in this role.

Do you work as a faculty member at an educational institution? *YesNo

If you answered yes to the previous question, please list the courses you teach, the institution where you teach them, and the duration of your teaching experience.

Please attach your Curriculum Vitae *

No file chosen

OTHER PROJECTS RELATED TO HEALTH QUALITY AND PATIENT SAFETY

For AMEXCASEP, it is important to learn about its members’ experience in quality management projects, even if they are unpaid, as they contribute to improving healthcare quality. This information is valuable both for upholding our principles and for providing members with continuous development opportunities. Below, you will find various requests for information about your Quality in Health projects.

Have you participated in Health Quality and Patient Safety Management Projects? *YesNo

If you answered yes to the previous question, please list up to three of the most significant projects you have participated in, specifying where they were developed and the time period, in chronological order from the most recent to the oldest.

Please attach the proof of payment *

No file chosen

Mexican Association for Quality in health and Patient Safety

Privacy Notice

33 2182 1982

amexcasep@gmail.com