Sponsor Name *

First Name

Last Name

School Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

OAMJHSC Participation *

Must have a minimum of 3 points

Attend Fall Conference (2 points)

Write Newsletter Article (Required| 1 point)

Complete 3 Extra Service Projects (1 point)

Advisor Serves on Executive Board (2 points)

Hold State Office (2 points)

Recruit New School to Fall Conference (2 points)

I certify that all required information has been included. *

Yes