2020 Conference Representative Registration

GT AMSA's 16th Annual Pre-Health Conference: Representative Registration Form
Thank you for considering Georgia Tech AMSA's 16th Annual Pre-Health Conference! This year's health professions information fair will be held virtually through Gatherly on February 26th, 2022 from 1:15pm to 2:30pm. The price for registration will be $25 for access to an information booth.

Please feel free to contact our Conference Coordinators at conference.gtamsa@gmail.com with any questions or concerns. We look forward to seeing you there! For more information, please visit https://gtamsa.weebly.com/ . We will be continuously updating our site as more details are finalized!
Name*

PrefixFirst NameLast NameSuffix
School*
Title*
List All Programs Represented*
ie. MD, MD/PhD, PA, DO, Pharmacy, Nursing, etc.
E-mail*
Phone Number*

Area CodePhone Number
Number of Additional Representatives*
YesNo
Additional Information and special requests
Enter Payment amount below ONLY if you plan to pay online. The cost is $25.00 for a representative. *If you plan to send a check, please DO NOT fill this box out!

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USDYou will be redirected to a PayPal window after hitting the "Register" button below. If you submitted a workshop proposal and it is not accepted, you will be contacted at a later date to pay the remainder of the registration fee.
If you prefer to make your payment via check, please do not put in any numbers in the Paypal box above. Instead, please check the box below. All checks need to be mailed to:

Ritika Chanda
564 Centennial Olympic Park Dr NW #0719-A
Atlanta, GA 30313

The check should be written out to "Georgia Tech AMSA". You will receive a confirmation email upon receipt of your check. If you need an invoice, please email us at conference.gtamsa@gmail.org, otherwise an invoice will not be sent to you.
Please check if you plan to send a check - signifies that you are acknowledging the following: I will be sending a check by mail. I understand that my registration for the conference is not confirmed until my payment as been received.
Further contact e-mail
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GT AMSA's 16th Annual Pre-Health Conference: Representative Registration Form