BMES Student Chapter Application/Renewal Form

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

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

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

New application

Renewal application

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

undergrads

grads

both

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

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

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

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

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

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

* 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.