Wisconsin HOSA Chapter Advisor Contact Information Form
Instructions - Please complete this form if you are:
1) a NEW HOSA Advisor OR
2) a CURRENT HOSA Advisor and your contact information has changed.

This will allow you to be active on the chapter advisor email distribution lists. Completing this form will provide you with communications regarding HOSA information and events. 

NOTE: You must be an annual affiliated member of HOSA, advisor division, in good standing in order to remain on this list. Those that have not paid dues within an 18-month period will be removed.
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First and Last Name *
Position (select all that apply) *
Required
Which HOSA membership divisions are you advising? (select all that apply) *
Required
Educator License Area (select all that apply) *
Required
School Name (full name preferred) *
School Mailing Address (street, city, zip code) *
Email Address *
Work Phone Number (with extension) *
Cell Phone Number (only to be used at HOSA events you are attending and we need to reach you for urgent matters). *
HOSA Chapter Name (if different from school name)
Please add me to the following contact lists (check all that apply). *
Required
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