Form

Chapter Creation Form

Complete this form to create your Global Medical Squad chapter and choose your chapter's 'Squad Goal' to receive your Chapter Promotion Kit!

Chapter Leader First Name*

Chapter Leader Last Name*

Phone number

Email*

Proposed Chapter Name

Select a name for your chapter (does not need to be school affiliated, ie. may be your HOSA club name or your region)

What is your Global Medical Squads Goal?*

In which programs(s) are you most interested? Mark all that apply.

Global Medical Academy - Summer Small Group Travel (Fixed dates in June-min 3+ students)

Global Medical Squads - Custom Group Travel (You choose the dates-min 12 students)

Affiliation*