General Information

If applying for more than one ACS H.O.P.E. subcommittee, please complete one application per subcommittee.

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* 1. Name and Credentials

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* 2. ACS Member ID Number (please indicate if not known or not applicable)

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* 3. Institution/Organization

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* 4. Business Address

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* 5. Preferred Contact Information

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* 6. What are your pronouns?

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* 7. What is your race?

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* 8. What is your specialty/subspecialty? Check all that apply

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* 9. What other ACS committees or subcommittees are you applying to? (You may apply to up to 2)

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* 10. Please list other ACS committees or subcommittees you currently serve on.

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* 11. Please attach your CV or bio sketch

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 12. Which ACS H.O.P.E. Subcommittee are you applying to?

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