gmt membership application 2011 2012

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					                                                               GLOBAL MEDICAL TRAINING
                                                                                                                                          at UCLA

                                                                            Membership Application 2011-2012

APPLICANT ELIGIBILITY
           Must   be a UCLA affiliate – student, staff member, faculty, alumni
           Must   submit this application along with a $15 membership fee
           Must   attend at least 1 fundraising event hosted by GMT per quarter
           Must   attend at least 1 volunteer service event per quarter
           Must   attend 5 general meetings per quarter
Last
                                                       First                                       M.I.                            Date
Name
                                                                                                                      Year in
Sex        M/F      Major                                          Expected Year of Graduation
                                                                                                                      School
Street
                                                                                                          Unit/Apartment #
Address
City                                                   State                                              ZIP

Phone                                                  E-mail Address

Please Circle
                         Pre-Medical      Pre-Dental   Pre-Pharmacy     Pre-Nursing   Pre-Veterinarian    Undecided       Other:
One
Career
Goals




PLEASE ANSWER THESE QUESTIONS
   1.      Do you have a car? Will you be able to drive?


   2.      Please list all trips you plan to attend.



   3.      What are some topics you would like us to cover during our workshops?




   4.      What are some volunteer events you would like to participate in through GMT?




   5.      Come up with a unique fundraising idea for GMT.




   6.      How did you hear about GMT?

				
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