AMSA New Membership Application

-Submit this application, the American Medical Student Association University of Houston Premedical Honors Chapter will evaluate and make a decision regarding the status of your application.
-After being accepted, you may proceed with paying the national and local dues.
-Once you pay your national dues, send a screenshot of the receipt at amsa.houston@gmail.com to confirm your national membership.
-After submitting this application, please follow the instructions under step 2 on our website to become a national member.


In order to be considered an active member and be eligible for top member or officer positions, you must pay your national dues. Perks include a Kaplan biochemistry course and MCAT flashcards.

The deadline for submitting an application is the SECOND GENERAL MEETING (9/17/2019) and deadline to pay your local dues will be the THIRD GENERAL MEETING (10/1/19)
Name? (First, Last) *
Your answer
Email address? *
The email you provide will be used to send event times, location, details, etc.
Your answer
Phone Number? *
Your answer
People Soft ID? *
Your answer
Major, Minor? *
Your answer
Classification: (by year NOT by credits) *
Type of Membership?
**Membership is not finalized until payment. Feel free to email us at amsa.houston@gmail.com" with any questions. You can pay in person or online using the links under the join tab.
Shirt size: *
Where did you hear about us? *
What do you aspire to accomplish through AMSA? *
Your answer
What kind of events/opportunities/speakers would you like AMSA to provide you? *
Your answer
I authorize the verification of the information provided on this form is true to the fullest of my knowledge. By applying for membership and upon acceptance, I authorize that AMSA may use such photographs of me for any lawful purpose, including for example such purposes as publicity, illustration, advertising, marketing and Web content. *
Have you paid your AMSA national dues? *
If you have any concerns feel free to email us. Don't forget to send a screenshot of the receipt at amsa.houston@gmail.com to confirm your membership.
By submitting this form I understand that I am not an official member of AMSA until my membership fee is paid. *
If you haven't already joined AMSA national, please follow the instructions listed under step 2 on our website under the join tab, and don't forget to email us proof of your national membership. Once you've received an acceptance email you can pay your local dues either online or in person. If you have any additional questions please email us at amsa.houston@gmail.com
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service