Chapter Roster

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:

Letter to Prospective Chapters
Guidelines for New Chapters
HMA Chapter Application
HMA Chapter Bylaws

Chapter Annual Report Forms:

Report Instructions

Financial Report

Officer Roster Report

Chapter Activity Report

Annual Report Extension Form

To Chapter Contacts

Contact Us • Who We Are • Events • Faith Health Issues • Search • Home