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Confirm password:  
E-Mail Address:  
Confirm e-mail:  
     
Your first name:  
Your last name:  
Year in school:  
Major(s):  
Minor(s):  
Emphasis:  
Phone number:  
Current address:  
Preferred Contact:  
 
Select all days you could attend healthsites this semester:








Are you able to drive?



 
     
If yes, how many people?  
     

The following questions are required, but are meant to give us an idea of what types of qualifications our members have so that we can better organize events. Please be honest and do not feel like you need to impress us. We want to include everyone in our activities.

What about CHIP excites you most?
Please describe your past volunteer activities?
What do you think of when you hear "chip" (eg: snack food):