REGISTER your GSA with GSA Network First, please enter the string shown in the image in the form. The possible characters are capital letters from A to Z. Your email address: Name of your school: City: State: Name of your club: Student leader's first and last name: Student's graduation year: Student's email: Student's phone number: Student's address, city, state and zip code: Check here if we need to be discreet when contacting student Advisor's name (you can enter more than one): Advisor's email: Advisor's phone number at school (including area code): Advisor's phone number at home (including area code): Tell us about how and when your GSA got started: Tell us how GSA Network can help your GSA: Any other comments: You can also print and mail this registration form to: GSA Network 1550 Bryant St., Suite 800 San Francisco, CA 94103 Fax your registration form to: 415.552.4729 If you have questions, please contact: register@gsanetwork.org or call 415.552.4229

For more information or for hard copies of our resource sheets, contact GSA Network: Statewide Office: 1550 Bryant St, Suite 800, San Francisco, CA 94103, ph: 415.552.4229, fax: 415.552.4729 Central Valley Regional Office: 928 N. Van Ness Ave., Fresno, CA 93728, ph: 559.268.2780, f: 559.268.2786 Southern California Regional Office: 1145 Wilshire Blvd #100, Los Angeles, CA 90017, ph: 213.482.4021, f: 213.482.4027