Register Your GSA

Fields marked with an asterisk (*) are required.

Your email address:*

Name of your school:*

City:*

State:*

Name of your club:*



Student Details

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:


What is the best way for us to contact you? Email Phone Call Text Message Facebook



Advisor Details

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):



General Details

Tell us about how and when your GSA got started:*

Tell us how GSAFE can help your GSA:*

Any other comments:*

I would like to have my GSA published in the Wisconsin GSA Directory, which will go on the GSAFE website:	Yes No


	Please enter the security code

You can also print and mail this registration form to:

GSAFE
122 E. Olin Ave. Ste. 290
Madison, WI 53713

Fax your registration form to:
(608) 661-1360

If you have questions, please call us at 608-661-4141.

Testimonials

“The summer after my first year of high school I attended LTI, GSAFE’s camp for youth leaders. I hold those four days dear to my heart and firmly believe that they were instrumental in transforming my life.” – Haruka, Former GSAFE Youth Activist