AMSA

AMSA Local Chapter Officers

Please notify the national office of your new officers so your chapter receives materials and important information throughout the year. Submit your new officers online, call 800-767-2266 or mail appropriate contact information to: AMSA Membership, 1902 Association Drive, Reston, VA 20191.

All chapter officers MUST be members of NATIONAL AMSA. If you are not, please join now. We will verify membership upon receipt of this form. Also note that your contact information will be made available to AMSA's national leadership via a password-protected web page, accessible only by national leaders.

Note: If you list a PO box as your address, you may not receive all mailings.

Please provide the following information. All fields are required. Please list each student only once.

SCHOOL:

Note: If you are submitting officers for a premedical chapter that is not already chartered and represented in this drop-down list, please contact AMSA Membership (800.767.2266) to provide the additional information.
 
PRESIDENT
Name: AMSA ID:
Address:
Phone: E-mail:
 
VICE PRESIDENT
Name: AMSA ID:
Address:
Phone: E-mail:
 
RECRUITMENT COORDINATOR
Name: AMSA ID:
Address:
Phone: E-mail:
 
LEGISLATIVE REPRESENTATIVE
Name: AMSA ID:
Address:
Phone: E-mail:
 
NATIONAL PRIMARY CARE WEEK REPRESENTATIVE
Name: AMSA ID:
Address:
Phone: E-mail:
 
LOCAL EXCHANGE OFFICER
Name: AMSA ID:
Address:
Phone: E-mail:
 
LOCAL OFFICER OF RESEARCH EXCHANGES
Name: AMSA ID:
Address:
Phone: E-mail:
 
PRE-HEALTH ADVISOR (PREMED CHAPTERS ONLY)
Name: AMSA ID:
Address:
Phone: E-mail:
 
CHAPTER PREMEDICAL CLUB ADVISOR (PREMED CHAPTERS ONLY)
Name: AMSA ID:
Address:
Phone: E-mail:
 
CHAPTER OFFICER TITLE:
Name: AMSA ID:
Address:
Phone: E-mail:
 
CHAPTER OFFICER TITLE:
Name: AMSA ID:
Address:
Phone: E-mail:
 
CHAPTER OFFICER TITLE:
Name: AMSA ID:
Address:
Phone: E-mail: