Student Chapter Membership Recruitment Fair Form

The Student Association of the American College of Osteopathic Family Physicians aims for 100% membership at each college of osteopathic medicine. The Student Membership Recruitment Committee is here to assist you in developing and implementing events. Additionally, you have $1,000 available for chapter activities throughout the year to support membership recruitment and family medicine chapter-related events. For more information, contact your NSEB liaison or email students@acofp.org. Please complete the form below to indicate your chapter's membership recruitment needs.

Name of College of Osteopathic Medicine ^*

Other COM not listed above

What is the date of your first chapter recruitment event on campus?

Who is the chapter contact for the membership recruitment event?

First name^*

Last name^*

ACOFP will mail a box to use at your recruitment events including giveaways, membership flyers, membership applications, table runner and tshirts for your board.

Approximately how many of each items (giveaways, postcards) do you expect to need?

Do you need an ACOFP table runner/cover?

Any other requests or details for ACOFP to help with?

Mailing Address

Name

Street Address^*

Street Address Line 2

City^*

State^*

Zip Code^*

Cell Phone Number

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