Alpha Chi Sigma: LA Pro. Chapter

L.A. Pro. Member Survey

 

CONTACT INFORMATION      

Full Name:

Suffix: Member Status:  
Initiation Year:   Initiating Chapter:
 
               E-mail:  
Phone Number:

Check here if you want to be included on our general e-mail list:

Preferred method of Contact:
E-mail Phone Mail

 

Please update your contact information:

Street: Apt.
   City: State: Zip:    
         
         
CHAPTER GOVERNANCE
Are you interested in holding office? Yes No
Are you interested in chairing a committee? Yes No
Are you interested in being on a committee? Yes No
 
 

PROFESSIONAL INTEREST
Please select all activities you are interested in.

Chemistry outreach (suggest outreach )

Tutoring
Chemistry magic show
Lecture on industry or technical issues relating to chemistry (suggested topic )
Suggest Event:
 
Would you be willing to organize or host a professional event? Yes No
 
 
SOCIAL INTEREST
Please select all activities you are interested in.
Beach picnic event
Movie/theater night
Athletic event (hike, softball, etc.) (suggested activity )
Wine tasting / Cheese & wine social
Suggest Event:
 
Would you be willing to organize or host a social event? Yes No
 
         

GENERAL COMMENTS