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* 1. Name and credentials

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* 2. ACS Member ID Number (if applicable/known)

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* 3. Institution/Organization

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* 5. Business phone

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* 6. Specialty. Check all that apply.

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* 8. Please attach your CV or bio sketch. (PDF format)

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* 11. Describe your contributions to the committee during your membership term. (250 words)

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* 12. Describe your vision for the committee and why you want to serve as the chair or vice-chair of the committee. (250 words)

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* 13. Please share any other leadership role(s) you have served in with ACS or other organizations. (250 words)

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