HMA CHAPTER OFFICER ROSTER

President
Name: ______________________________________________
Address: ______________________________________________
______________________________________________
Phone: Day (____)____________ Evening (____)____________
Email _________________________ Fax (____)____________
Vice-President
Name: ______________________________________________
Address: ______________________________________________
______________________________________________
Phone: Day (____)____________ Evening (____)____________
Email _________________________ Fax (____)____________
Secretary
Name: ______________________________________________
Address: ______________________________________________
______________________________________________
Phone: Day (____)____________ Evening (____)____________
Email _________________________ Fax (____)____________
Treasurer
Name: ______________________________________________
Address: ______________________________________________
______________________________________________
Phone: Day (____)____________ Evening (____)____________
Email _________________________ Fax (____)____________

Email contact designation:
[   ] The Chapter President/Chair shall act as the chapter email contact.
[   ] The Chapter Secretary shall act as the chapter email contact.
[   ] Someone other than the President/Chair or Secretary shall act as the chapter email contact. Please include all contact information for this person on the reverse of this form.
[   ] Chapter Web site address: _______________________________


HMA Chapter Roster

New Chapter Information:

Chapter Annual Report Forms:

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Health Ministries Association (HMA)
P. O. BOX 7187 ATLANTA, GA 30357-0187 (800) 280-9919 (404) 607-9357
FAX: (404) 607-9358 E-MAIL: hmassoc@mindspring.com
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