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International Chapter Delegate Certification Form

AMERICAN MEDICAL STUDENT ASSOCIATION
2009 HOUSE OF DELEGATES

Online Application Deadline: March 2, 2009

star This form is for International chapters only. Continue below if you're an International chapter officer.
star Medical chapters need to register delegates on the Medical Delegate Form.

Each chartered International Chapter shall be entitled to one (1) voting delegate in the House of Delegates (HOD) of the Association for every two hundred fifty (250) medical student members, or fraction thereof, of said chapter. The total number of delegates from all international chapters shall not exceed the total number of regions in the Association (10). If more than ten (10) delegates wish to vote, designation of delegates shall be based firstly on the proportional number of delegates eligible from each chapter (according to the number of medical student members) and secondly on the order in which chapters register their official delegate(s) for the annual meeting.

Since the total number of delegates from all international chapters exceeds the total number of regions in the Association (10), designation of delegates will be based on the proportional number of delegates eligible (from active membership in your chapter) and then further by the order in which international chapters submit their registration of their delegates from this form to the national office.

This form must be submitted by the chapter president or approved by the chapter president. An automatic email will be generated to your Chapter President once the form is submitted notifying the chapter president of the submittal.

By submitting this form, I declare the following delegates are AMSA international member(s) and THE DULY ELECTED (or appointed) DELEGATE(S) of the American Medical Student Association Chapter at international school, and is (are) an active member(s) in good standing of the association, and as such, is (are) authorized to represent the above constituent organization in the deliberations of the HOD of the AMSA.

Your Name:
Your Email Address:
Your Chapter President's Name:
Your Chapter President's Email:

DELEGATE 1:

Name
AMSA ID No. Graduating Year
Address
Room/Apt. No.
City/State/Zip
Telephone
Email

DELEGATE 2:

Name
AMSA ID No. Graduating Year
Address
Room/Apt. No.
City/State/Zip
Telephone
Email

DELEGATE 3:

Name
AMSA ID No. Graduating Year
Address
Room/Apt. No.
City/State/Zip
Telephone
Email

DELEGATE 4:

Name
AMSA ID No. Graduating Year
Address
Room/Apt. No.
City/State/Zip
Telephone
Email

Click here for a print version of this form to submit via USPS mail. Forms must be postmarked by February 13, 2009 to ensure receipt prior to convention.

   
   
 
 
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