Affiliation Form

Submitted by IT on Wed, 03/17/2010 - 7:04am

MSA National Chapter Affiliation

Please fill in all information below to be registered as an affiliated chapter of MSA National. Your chapter will receive several perks which include one free representative from your chapter to your annual Zonal Conference (starting in Fall 2010), voting privileges, and access to our MSA National member card (coming soon). MSA National serves primarily to guide and mentor MSA chapters across North America and develop tomorrow's leaders. In line with this vision, MSA National's policy is never to impose nor interfere in local chapter business.

School Information

Board Term: *

School Name: *

Name of MSA Chapter: *

Chapter Email: *

Zone: *

Total Members: *

Website: *

Mailing Address

Phone Number: *

Fax:

Street Address: *

Address Line 2:

City: *

State/Province/Region: *

Postal/Zip Code: *

Country: *

Officers/Shura Members

None of this information will be shared with anyone outside of MSA National. Our only purpose is to connect chapters with chapters and with MSA National.

President: *

Full Name

President's Email: *

Vice President: *

Full Name

Vice President's Email: *

Treasurer: *

Full Name

Treasurer's Email: *

Secretary: *

Full Name

Secretary's Email: *

Does your MSA have an email mailing list?: *

Yes

If yes, periodically MSA National needs to communicate with affiliated chapters. Can MSA National post important and infrequent messages to your emailing list?: *

Yes

(Enter no if you answered no above)

Mailing list manager's email: *

(type N/A if you entered no above)

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