New Student Orientation Event Form

New Student Orientation Event Form
Complete this form with information regarding your orientation event plans. Feel free to contact TMA-Medical Student Section Staff, Karen Kollar, at karen.kollar@texmed.org, with any questions you may have. We need at least 3-4 weeks lead time to mail materials and plan for an onsite representative
University Name
Chapter Recruiter/Contact Person *

First NameLast Name
Chapter Recruiter/Contact Email*
example@example.com
Chapter Recruiter Cell Phone Number

Area CodePhone Number
Address - provide an address that TMA can use when mailing recruitment materials.

Street Address

Street Address Line 2

CityState

Zip Code
Type of Event*

Multiple Organizational FairPresentationMixer/DinnerChapter Recruitment TableOther
Tell us more about the type of event and/or any role TMA could play.
Example: setting up a booth, providing a brief presentation on the benefits of membership, etc.
Orientation date
Time of the orientation event (Start and EndTimes)
Orientation Location
Orientation Location Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Number incoming first year class
The number of member benefits packets we send to you will be based on this number.
Is TMA participation within your event possible?

YesNo
Will your chapter opt into TMA’s 100% Student Membership Program?

YesNo
Will your chapter opt into TMA’s 100% Student Membership Program?

YesNo
Who will be providing your chapter roster to TMA-MSS staff?

Chapter OfficerSchool Staff
Who will be providing your chapter roster to TMA-MSS staff?

Chapter OfficerSchool Staff
100% member roster - school staff contact name

First NameLast Name
Staff contact title
Staff contact email
example@example.com
Staff contact phone number

Area CodePhone Number
100% membership roster - chapter officer contact name

First NameLast Name
Chapter officer contact email
example@example.com
Chapter officer contact phone number

Area CodePhone Number
Should be Empty: