Student Representative Application Form

We can’t wait to hear from you!

Please fill out the form below, and we’ll get back with you soon!


  1. (required)
  2. (required)
  3. (valid email required)
  4. (required)
  5. Is there an AMSA chapter at your school?
  6. If your school has an AMSA chapter, are you an active member?
  7. Captcha

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