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General Information

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* 1. Name

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* 2. Email Address

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* 3. What State Do You Live In

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* 4. Please Select Your Sorking Staus

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* 5. If you selected other, please tell us what you do

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* 6. Are you currently involved with a student or professional chapter? Please answer Yes or No. If yes, which chapter 

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* 7. What information are you most interested in receiving from NOBCChE (as it relates to membership activities)? 

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* 8. IF other, please specify

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* 9. Are you interested in volunteering for any of the following activitiess?

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* 10. Have you received a job opportunity or internship as a result of NOBCChE?  I so, please provide details

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* 11. Please provide feedback on what NOBCChE can do for you and any other comments you may have. 

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