MEISA Chapter Registration

By becoming a registered MEISA chapter you will help us help you take full advantage of MEIEA and MEISA resources. Please fill in and submit the chapter registration form below. There is no cost to register your chapter.

Registration Submitted by: (Name: First Last)
Contact Email Address:
REGISTRATION TYPE	New Chapter (established less than 1 yr) Updating/Renewing Chapter
Year Established
Institutional Information
Institution
Department or Division
Faculty Advisor (First Last)
Advisor Phone
Advisor Email
Chapter Web Address
Mailing Address 1
Mailing Address 2
City
State
or Province
Country (if not US)
Zip/Postal Code
Chapter Information
Chapter Email Address
Chapter Office Phone Number
Number of members
Chapter dues (dues paid in addition to MEIEA membership)
Recent Activities: List & describe any significant activities your chapter has sponsored in the most recent academic year.
Officer Information
President (Name: First Last)
President Email
President Phone
Vice President (Name: First Last)
Vice President Email
Vice President Phone
Secretary (Name: First Last)
Secretary Email
Secretary Phone
Treasurer (Name: First Last)
Treasurer Email
Treasurer Phone

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