Report of Initiation by R7OqsR


									           Iota Sigma Pi
           National Honor Society for Women in Chemistry

                                              Summary of Applicants
          To Be Submitted by Chapter Treasurer - Complete one Summary of Applicants per chapter initiation.

Chapter                         _______________________________________________________________________
Chapter Mailing Address         ______________________________________________________________________
                                 (City, State)                        (Zip Code)
Date of Initiation              _____________________          Date of Report      _______________________________

Please type the names as you would like them to appear on the membership certificates.
List the names of applicants in alphabetical order, last names first. Choose P for professional or S for student in the last
column. Indicate complete mailing addresses. Use the second page as needed.

            NAME                            MAILING ADDRESS                             EMAIL ADDRESS                 P or S

Enclose the membership application form for each of the above applicants along with this report.
 I have checked that the applicants meet the requirements of membership as described in the Rules and Regulations.
Dues plus initiation fees enclosed: Number of Student Members       ________         x $45 = $ _________
                                      Number of Professional Members ________             x $80 = $ _________
                                                                    TOTAL                       =     _________
Make check payable to Iota Sigma Pi
Submitted by: ____________________________________________________ (Chapter Treasurer)
E-mail address: ______________________________________ Phone number: _____________________________
Chapter Treasurer retains one copy and sends three copies of this report, one application for each name, and a single
check for the total amount to the Supplies Coordinator. This form is available electronically from the National Secretary
or the Iota Sigma Pi website. Please submit report 3 weeks prior to the scheduled date of initiation.
NC Summary of Applicants Form                                                                                Revised 07/01/2012
            NAME                MAILING ADDRESS   EMAIL ADDRESS            P or S

NC Summary of Applicants Form                                     Revised 07/01/2012

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