Join our SAA HOSA

Remind 101
Text: @saahosa
To: (912) 303-5768
Or visit:
www.saahosa.weebly.com
HEALTH OCCUPATIONS STUDENTS OF AMERICA
APPLICATION FOR MEMBERSHIP
The mission of HOSA is to enhance the delivery of compassionate, quality health care by providing opportunities
for knowledge, skill, and leadership development of all health science technology education students, therefore,
helping students to meet the needs of the health care community.
Name:
(First) (M.I.) (Last)
Grade: ________ Ethnicity: _____________________ Gender: _______ T-Shirt size: ________
Full Street Address: ________________________________City: ____________ State: ______ Zip Code: _________
Student Email Address: ____________________________________ Student Cell Phone#: ( ) ______________
Parent Name:________________________________ Phone:_______________(H) _________________(C)
Email Address: ______________________________________________________________
Parent Name:________________________________ Phone:_______________(H) _________________(C)
Email Address: ___________________________________________________ Major: ________________________
Career Interest:
Note: Chapter meeting and officer meetings may be held once or twice a month. Active members are given priority when
selecting students to attend workshops and conference. Announcements can be found on the chapter website, facebook
page, remind 101 texts, email, twitter, instagram, and outside of Mr.Williams’ room throughout the school year. I
understand that the membership dues are $25 and there are additional fees (hotel, food, transportation, supplies,etc.) to
attend conferences or for other necessary uses.
Student Signature : _________________________________________ Date: ___________________________
FOR OFFICIAL USE ONLY:
Paid ______
Updated Spreadsheet ______
Added to Online Database _______
HOSA Member ID#_____________________
Return to Mr. Williams (Rm. 216)
BLOCK COURSE TEACHER ROOM #
ADVISEMENT
A Day 1
st
Block
3
rd
Block
5
th
Block
7
th
Block
B Day 2
nd
Block
4
th
Block
6
th
Block
8
th
Block

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