ESG - Initiation Application

INITIATION CEREMONY: TBA

DEADLINE FOR APPLICATION: TBA
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REQUIREMENTS
- Health Promotion or Administration Major or Minor
- Sophomore or above
- HPR Club Member with active participation in activities
- GPA = 2.70 or above (major OR cumulative)
- Active membership/participation in Eta Sigma Gamma
INITIATION FEE = $50.00 - Includes
- Eta Sigma Gamma pin
- Subscription to the Health Educator - official journal of ESG
- Membership certificate
- 2019 National dues (you will need to pay yearly national dues to maintain your membership)
- Refreshments
Name Name * First Last
Home (permanent) address Home (permanent) address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Local address Local address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone * - ### - ### ####
Email address *
GPA *
Year in school *
List Eta Sigma Gamma activities in which you have participated *
1. COMPLETE THIS FORM
2. PRINT THIS FORM.
3. BRING THE FORM ALONG WITH PAYMENT ($50.00)TO THE OFFICE MANAGER IN THE DEPARTMENT OF HEALTH PROMOTION.
4. LATE FORMS CANNOT BE ACCEPTED - NO EXCEPTIONS!!!
5. Checks should be written to: Eta Sigma Gamma
Date Date / MM / DD YYYY