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Involvement in ACS:How long have you been a member of the Virginia section of ACS? enter text.

Have you been a member of another section of ACS in the past? enter text.

What areas are you interested in volunteering for (check all that apply):

☐ Mentoring Program ☐Young Chemists ☐Women Chemist Committee ☐Minority Affairs

☐ Chemistry Olympiad ☐Chemistry Week ☐Chemistry Education ☐Membership

☐ Media Relations ☐Project SEED ☐Student Affairs ☐Other: enter text.

Reasons you joined ACS: Click here to enter text.

Demographics:What county and city do you live in? Click here to enter text.

List colleges and universities you attended and degrees obtained:Click here to enter text.

Who is your employer (if student, write “student” and school)?:Click here to enter text.

What type of chemistry is your focus (e.g. organic, physical, etc.)?Click here to enter text.

Tell us a little bit about yourself:Click here to enter text.

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Virginia Section of the American Chemical Society (ACS) New Member Information Sheet for “Buddy” Matching