Chapter Officers Conference
Online Registration Form
July 17-20, 2008

If you do not wish to register online, you may print out a registration form and mail it to the national office.

REGISTRATION DEADLINE: June 16, 2008

Name:
AMSA ID: (if known, 6 digit number on your TNP label)
Address:
(summer)
Phone:
E-mail:
Student Type: Medical International Premedical
School:
Location:
Grad. Year:
Gender: Male Female

I PLAN TO ARRIVE AND DEPART:

Arrive: (date) (time)
Depart: (date) (time)

PREFERENCE OF ROOMMATES:
There will be four people (same gender) in a room. You may request someone from your region, specific individuals, etc.

LOBBY DAY REGISTRATION:

To Be Announced

FOOD PREFERENCE:
vegetarian non-vegetarian
 If other, specify:

OTHER SPECIAL NEEDS:
(wheelchair access, hearing disability, etc.)

REGISTRATION FEES: Please check one
Medical Chapter $150.00
Premedical Chapter
Premed chapter officers wishing to attend are REQUIRED to contact AMSA's Premedical Trustee for prior approval and details.		 $150.00
International Chapter
International chapter officers wishing to attend are REQUIRED to contact AMSA's International Trustee for prior approval and details.		 $150.00

Charge $150 to my: MasterCard    VISA
Card# (no dashes):   Exp. Date:

REFUNDS: are issued only if cancellations are received prior to July 3.

COC REGISTRATION FEES COVER:

Hotel accommodations will be made for you (four attendees of the same gender to a room) if you return your registration form BEFORE the deadline date of June 16, 2008. Accommodations will be available for Thursday, Friday and Saturday nights, but you MUST specify your arrival and departure dates and times on the registration form above.

Conference materials and meals. Materials will be handed out at the on-site registration table on Friday, July 18. Conference meals include Friday breakfast, lunch and dinner; and Saturday breakfast and lunch.

If you have any questions, please e-mail or call AMSA's membership services at (800) 767-2266, Monday-Friday, 9:00 am-5:00 pm, EST.

Copyright © 2008 American Medical Student Association