AMSA Registration Form 2021-2022

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We're so glad you want to join Georgia Tech AMSA!

To officially register, please fill out the following form in completion. If you have any questions regarding the registration process, please reach out to the VP of Membership, Patrick Kramer (pkramer6@gatech.edu). If you have any questions regarding dues, please reach out to the VP of Finance, Ivy Zheng (izheng6@gatech.edu).

Note: All AMSA members MUST register every year! You do NOT need to register if you registered in Fall 2021. You DO need to register if you are looking to join AMSA in Spring 2022.

This Registration Form is due on 2/11/22!

Name *

Major *

GTID (9 digit ID) *

GT Username (ex: gburdell3) *

GT Email Address (ex: gburdell3@gatech.edu) *

T-Shirt Size *

XXL

Professional Program Interest *

Pre-Medicine

Pre-Dental

Pre-PA (Physician's Assistant)

Pre-Optometry

Pre-Pharmacy

Nursing

Other:

How many years have you been in GT AMSA? *

This is my first year (Your dues are $75 national dues + $15 local dues = $90 total)

This is my second year (Your dues are $10 total)

This is my third year (Your dues are $5 total)

This is my fourth year or more (Your dues are free of charge)

Check all of the following programs/committees that you are interested in:

Advocacy Committee

Mentorship Program

Fundraising Committee

Urban Health and Wellness Team

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