2020 GSAHDA BOLD Application
Pre-dental membership into GSAHDA
Questions? Email gsahda2016@gmail.com
Email address *
Full Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Mailing Address (street address, city, state, zip code) *
Your answer
Permanent Address (if different than mailing address)
Your answer
Cell Phone # *
Your answer
Current Status *
School Information
Name of Current (or Recent) School
Your answer
Post Graduate Program, if applicable
Your answer
Date of Expected Graduation
Your answer
Degree Expected
Your answer
Does your school have a pre-dental student chapter?
If yes, what is the name & contact info of your Faculty Advisor?
Your answer
Survey Information (Optional)
What services would you like to obtain from HDA membership?
Your answer
Are you willing to participate in community activities with GSAHDA?
Ethnicity?
Your answer
How did you hear about GSAHDA?
Yearly Membership Dues: $25
Payment Method *
Thank you for your membership. We look forward to seeing you at our general meetings, socials, learning events, and community outreach events. Make sure to add Greater San Antonio Hispanic Dental Association on Facebook for the latest updates.
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