UCF Pre-Med AMSA Signup Form

Submitted by PreMedAMSA on Sat, 06/27/2009 - 20:21

Please fill out the fields below to signup for UCF Pre-Med AMSA!

First Name: *

M.I.:

Last Name: *

Street Address: *

City: *

State: *

Zip Code: *

Country: *

Phone Number: *

Please use the following format: xxx-xxx-xxxx.

Alternate Phone Number:

Email: *

Birthdate: *

Please enter birth date in the following format: mm/dd/yyyy

SSN:

Gender:

Grad. Date: *

Type of Student: *

Major: *

Class Standing: *

The New Physician Subscription:

Yes

AMSA members are entitled to receive The New Physician magazine, published nine times a year.

Voluntary Information:

Please describe yourself (to be used only in aggregate form for research).

Release Information:

Do not release my address.

Do not release my email.

Do not release my phone number.

AMSA is committed to keeping members informed of important changes in medical education and health care delivery, especially where new and innovative opportunities are available. We aim to keep the announcements informative and infrequent.
AMSA has a strict review process for any information disseminated to members from external sources. Periodically, AMSA will inform its members of beneficial services available from these other entities, on a case-by-case basis, subject to approval by the AMSA Board of Trustees. If you do not wish to receive information from these AMSA-approved outside organizations, please let us know.

UCF NID: *

Please enter your NID above so we can add you to our point system records on the website so you can easily access your ranking among the members. Your NID will be used in place of your name to keep your information private from other members. (e.g. ab123456)

Committee:

Use Ctrl + Click to choose more than one committee.

Name on Credit Card (used in Paypal): *

Shirt Size: *