Application for the Sigma Beta chapter of Gamma Sigma Epsilon

							                        Gamma Sigma Epsilon
                       National Chemistry Honors Society
                                  Sigma Beta chapter

This application is for students interested in joining the Sigma Beta chapter of Gamma
Sigma Epsilon, the National Chemistry Honors Society as an associate member.
Membership requirements include
    enrollment at TCNJ as a chemistry major

Name:                                              (Last, First, MI)
Sex (M/F):       Date of Birth: __ __ /__ __ / __ __ __ __ (MM/DD/YYYY)
Classification: Freshman Sophomore Junior Senior (circle one)
Email address: ________________________
Estimated Graduation Date: __ __ / __ __ __ __
Minor(s):
____________________________________________________________
Campus Address (if applicable):
__________________________________
__________________________________
Cell Phone: (__ __ __ ) __ __ __ - __ __ __ __
School Extension: x __ __ __ __