LMSA Northeast Chapter Information Update Form
Email *
Chapter Information
Full School Name *
Example: SUNY Upstate Medical University
City, State *
CHAPTER EMAIL *
*MUST HAVE*
Social Media Handles
Name + Mobile number for chapter representative. *
The NE region has a chapter leader GroupMe. Please include the name + mobile number of the individual who should be included in the GroupMe.
Chapter Leadership
President Name *
President Email *
Co-President Name
(if applicable)
Co-President Email
(if applicable)
VP Name *
VP Email *
Treasurer Name *
Treasurer Email *
Secretary Name *
Secretary Email *
Other positions (please include full position name, full individual name and email).
Faculty Advisor(s)
Faculty Advisor Name *
Faculty Advisor Title *
Faculty Advisor Email *
Faculty Advisor Phone Number *
Questions/Comments/Concerns
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