Membership Application

Please fill out application and mail to : HSA,CC323,UAlbany, Albany, NY 12222.
Last Name:

First Name:

Class: 
Freshman Sophomore Junior
Senior Graduate Other
Specify if Other:    

Address 
Quad: Hall: 

Suite: P.O.Box:

Street: City:

State: Zip:

Local Phone: Cell Phone:

E-Mail:
Events you would be interested:  [Check all that Apply]
Konpa Workshop
Talent Show/ Male-Female Revue
Haitian Breeze
Dinner/Dance Gala
Barbecue
Committees you would like to join:  [Check all that Apply]
Arts (i.e Banner & Flyer Design)
Special Events Coordination
Public Relations

What other events would you like to see HSA have ? Any other comments /Suggestions? 

Do you have friends who might be interested in joining HSA?
Name:

E-Mail:

For further information email to : haitian_student@yahoo.com
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