Individual Membership Application Form Template



3290570-164465004643120-32639000Student Society for Global HealthMembership Application FormLifetime MembershipEligibility Criteria:Matriculated and current UTSPH-Health Science Center at Houston studentsFull Membership benefits include:Access to members-only scholarshipsEligibility to apply for school/university global health fundingAccess to Center for Global Health at UTSPHParticipate in global health research opportunities at UTSPHOpportunities to travel internationally for fieldworkMentoring on research and publishing in global healthNew member receptionsMonthly newsletterOpportunities to connect with fellow studentsOpportunities for professional development, leadership roles, and community serviceAccess to multi-faceted global health resources on local, national, and international levelsInvitation to annual Multicultural Dinner and other fun social eventsMembers-only networking events with regional universities and organizationsYour membership announcement in SSGH’s newsletter and on the SSGH websiteReview and discuss the latest global health trends with SSGH members, UT Medical School andBaylor College of Medicine studentsInvitation to local, regional, and national global health conferencesMembership ResponsibilitiesAs a member, your responsibilities are:To actively participate in meetings and events regularly (at least three meetings and/or events per semester)To provide clear and timely communication in response to meeting and/or event invitationsTo volunteer, when available, at community service eventsTo maintain professional conduct by treating fellow members and our guests with respect and courtesyTo help maintain a positive, friendly environment necessary for all members to learn and growTo pay membership dues on time (full membership only)To be an ambassador for SSGH and an advocate for global healthTo recruit new members for the organizationHow to JoinAll you have to do is complete our Membership Application Form! You can find this form on our website: Address: Zip Code:Email:Phone: Facebook name (optional):Please tell us a little about yourself:Who are you? A… FORMCHECKBOX Student FORMCHECKBOX Faculty/staff member FORMCHECKBOX Community partnerWhich university/organization are you associated with?If a student, what is your major?If a student, which program are you in? FORMCHECKBOX Undergraduate FORMCHECKBOX Master’s FORMCHECKBOX Doctorate FORMCHECKBOX Post-doctorateIf you are interested in participating in one of the SSGH committees, please tick appropriate box: FORMCHECKBOX Host Café events FORMCHECKBOX Multicultural Gala FORMCHECKBOX Domestic Trips FORMCHECKBOX International Trips FORMCHECKBOX FundraisingMEMBERSHIP FEE FORMCHECKBOX $15.00 Lifetime membership/subscription PAYMENT METHODS FORMCHECKBOX Cash FORMCHECKBOX Credit CardPlease complete this form & return to: SSGH treasurer, Timothy Clark , Timothy.B.Clark@uth.tmc.edu ................
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