The Muslim Students Association of the US and Canada

MSA National Chapter Affiliation

Please fill in all information in the form below. After submitting your information, you will be taken to the payment page where you will access our secure credit card processing area. If you have any questions about the affiliation process, please contact the MSA National office.

Online chapter affiliation form - Step 1 of 2

* denotes a required field

School Information
Academic Year *		Date *
School Name *		Zone * (help?)
Name of MSA Chapter *		Total Members
MSA Chapter Email *		Website

Mailing Address (Where you can receive materials)
Street *		City *
State / Territory / Province *		ZIP Code *
Phone *		Fax

Officers/Shura Members
President *		Email *
Vice President *		Email *
Secretary		Email
Treasurer		Email

Mailing Lists
Does your MSA have an e-mail mailing list? *			Yes No
Periodically MSA National needs to communicate with affiliated chapters. Can MSA National post important and infrequent messages to your mailing list?			Yes No
Email address of your mailing list:

Select your affiliation type: (CHOOSE ONLY ONE) *
College/University		High School
	1 Year - $25		1 Year - $10
	2 Years - $45
	4 Years - $75

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