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* 1. Contact Information: 

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* 2. Chapter:

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* 3. Since joining, what contributions have you made to your Chapter during the short period of membership you’ve held thus far?

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* 4. If you could improve one thing within your Chapter, what would that be and why?

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* 5. Please provide a letter of Recommendation from the immediate past President or Membership Orientation Officer:

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* 6. Please provide any additional information you would like to share with the Awards committee:

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* 7. Additional Supporting Documents or Letters of Recommendation:

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