May 16, 2008  

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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:
 
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:
 
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:

 

 


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