BMES Student Chapter Application/Renewal Form

At what university is this BMES Student Chapter located?

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* 1. At what university is this BMES Student Chapter located?

Please provide the Name and Email address of person submitting this application.

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* 2. Please provide the Name and Email address of person submitting this application.

Is this a new application or a chapter renewal application?

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* 3. Is this a new application or a chapter renewal application?

New application

Renewal application

Does this chapter primarily serve undergraduate students, graduate students or both?

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* 4. Does this chapter primarily serve undergraduate students, graduate students or both?

undergrads

grads

both

How many undergraduate students are enrolled in your university's BME program?

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* 5. How many undergraduate students are enrolled in your university's BME program?

How many graduate students are enrolled in your university's BME program?

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* 6. How many graduate students are enrolled in your university's BME program?

Who is the faculty advisor of your BMES student chapter?

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* 7. Who is the faculty advisor of your BMES student chapter?

What is the MAILING address for the BMES student chapter?

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* 8. What is the MAILING address for the BMES student chapter?

Please list the names of the BMES Student Chapter officers, their chapter positions and BMES student membership ID number.

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* 9. Please list the names of the BMES Student Chapter officers, their chapter positions and BMES student membership ID number.

Please list the names of the BMES student chapter members and their BMES Student membership ID number.

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* 10. Please list the names of the BMES student chapter members and their BMES Student membership ID number.

Does your student chapter or department have a website you'd like for us to connect to from the BMES Student Chapter webpages? If so, please provide us with a link.

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* 11. Does your student chapter or department have a website you'd like for us to connect to from the BMES Student Chapter webpages? If so, please provide us with a link.