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American Chemical Society

University of North Florida - Student Chapter

New Member Application Form


Name: ________________________________________________ Date: ____________
N#_______________________ Expected Graduation Date: _________________
Email: ___________________________________ Phone: ________________________
Chemistry Courses Currently Enrolled In:
______________________________________________________________________
Chemistry Courses Previously Taken:
_______________________________________________________________________
Favorite Activities To Participate In:
______________________________________________________________________
Availability to Attend Meetings:
_______________________________________________________________________
Availability to Assist with Meetings/Functions:
_______________________________________________________________________
Ideas/Expectations:

______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
______________________________________________________
-FOR ACS OFFICER USE ONLYDate Received: _________________
Date Processed: ________________
Initials: ________

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