Health Careers Organization
Membership Survey and Application


First Name:     
Last Name:      


Major:          
Biology 
Biochemistry
Biomed
Psycho-Bio
Psychology
Chemistry
Undeclared
Other
Status:	        
Freshman
Sophomore
Junior
Senior
Other
Where are you:  Dorms (Lothian)
Dorms (A + I)
Off campus apartments
Off campus housing
At home (commuting)
Non-UCR student



Are you an HCO member?
     yes
     no


If no, are you interested in becoming an HCO member?
     yes
     no


If YES, please leave your phone number.
     Phone: (optional) 
     E-mail: 



Would you like us to contact you on HCO meetings and events?
     yes
     no


Check off if you are interested in:
     Volunteering in General
     Hospital Events and Volunteering 
     Socials (Icebreakers, Stress-reilef, Banquet)
     Medical Speakers (issues, different professions)
     Med School and MCAT Speakers 
     Becoming an Officer 
     On-campus Projects 

Send your questions or comments: