Sign Up Form — Assyrian Student Association of Arizona

asa Membership application

Below is the Membership Application for the ASA available to all students and youth in Arizona. Please fill it out in its entirety. If you have any questions about this form, you may send us an email at info@asaofaz.com.

Name

First Name

Last Name

Date of Birth

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

College or School

If applicable

If "Other" is selected, please specify which school:

Major/Area of Specialty

Committee of Choice

Committees are subgroups in the ASA that plan projects according to their respective fields. Each member is required to serve on at least one committee. Below you can provide your first and second choice for committee participation.

Second Committee of Choice

If your first choice is not available

Electronic Signature Printed Name

You acknowledge and certify the information above for ASA membership, valid from the date of submission.

asa Membership application

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