Microsoft Word - recruiter_information.doc



Graduate School RecruitersMeet motivated chemistry undergraduates and share information about your working Social with Graduate School Recruiters at the 253rd ACS National MeetingSan Francisco, CA | April 2, 2017 | 1:00 – 5:00 p.m.REGISTRATION DEADLINE: March 11, 2017Register by January 9, 2017, to save $50!13208055245004561205225488500Event RegistrationThe registration fee is $249 prior to January 9, 2017. Registration will increase to $299 starting January 10, 2017. The information below will be shared with undergraduate meeting attendees and used to update our records. Please complete one form for each table you require.Institution:Click here to enter text.Representative’s name(s):Click here to enter text.Department, program, or specialty represented:Click here to enter text.Department, program, or specialty URL:Click here to enter text.Degree(s) offered:?Ph.D. ?Master’s ?Professional Master’s ? Other (specify): Click here to enter text.Mailing address:Click here to enter text.City/State/ZIP:Click here to enter text.E-mail:Click here to enter text.Phone:Click here to enter text.Wi-fi AccessPrior to January 9, 2017, you may purchase Wi-Fi access for $20 per device. Starting January 10, limited access to Wi-Fi may be purchased on a first-come, first-served basis.Please note that separate Wi-Fi access must be purchased for each device used.Payment total, through January 9, 2017OptionAmountEnter amount owed? Registration$249.00Click here to enter text.? Wi-Fi connection$20.00 x Click here to enter text. (# devices)Click here to enter text.Total amount owed: Click here to enter text.Payment total, January 10–March 11, 2017OptionAmountEnter amount owed? Registration$299.00Click here to enter text.? Wi-Fi connection (if available)$20.00 x Click here to enter text. (# devices)Click here to enter text.Total amount owed: Click here to enter text.Method of Payment The total amount owed (above) may be paid by one of the following methods:? Check? Purchase order Email registration form to Blake Aronson (b_aronson@) by March 11, 2017.Submit payment/forms to: Robin Lindsey, Undergraduate Programs Office, American Chemical Society, 1155 Sixteenth St. NW, Washington, DC 20036-4839 ? Visa? MasterCard? American ExpressCard numberClick here to enter text.Expiration dateClick here to enter text.Cardholder nameClick here to enter text.SignatureEmail completed form to Blake Aronson (b_aronson@) by March 11, 2017.Check and credit card payments must be received by March 11, 2017.Purchase order payments must be received by April 30, 2017 ................
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