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Chapter Information |
| Chapter Name * |
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| Year of Report |
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| URL |
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| Sponsor/Advisor Information |
| Member # * |
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| Name * |
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Incoming Officer Information 2003-2004 |
| Chair |
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| e-mail |
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| Vice-Chair |
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| e-mail |
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| Secretary |
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| e-mail |
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| Treasurer |
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| e-mail |
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| Chapter Census |
| Address |
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| E-mail Address |
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| Phone Number |
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| Fax Number |
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| Total # of members |
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| # of ACM members |
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# of meetings
in this year |
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| Average Attendance |
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| Description of Activities |
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Please take a moment to let us know about any particularly significant chapter events in
the past year (symposia, conference participation, successful
fund-raisers etc.) |
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| Financial
Activities |
General Instructions:
Form must be completed by every ACM Chapter, Student Chapter, and
Local SIG, regardless of whether financial activity has taken place,
whether the group wishes to be included with ACM's Group 990 return,
or whether the chapter is located outside the United States. ACM Bylaw
9,section 4, requires that all chartered ACM Local Groups must report
to the Association on their financial activity every year. |
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| Chapter Name: |
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Opening Balance ($)
(cash on hand and in the bank as of July 1, 2002) |
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| Total cash receipts ($) (revenue): |
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| Total cash disbursements ($) (expenses): |
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Ending balance ($)
(cash on hand and in the bank as of June 30, 2003): |
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Other liabilities
(notes or loans): |
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Other assets
(value at cost): |
$
$
$
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| Explain: |
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| List all banks & accounts numbers
(identify any accounts opened or closed during the fiscal year): |
bank name account number
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| Comments and explanations: |
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I hereby certify that the above information has been examined by me and to
the best of my knowledge I believe that it is true, correct, and complete,
and made in good faith for the fiscal year stated.
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| Chapter chair: * |
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| Chapter treasurer: * |
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| Date: * |
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ACM Authorization form for Filing with a Group Form 990 Return : |
| Name of Chapter: |
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hereby:
(Please check the
applicable box)
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( ) authorizes ACM Headquarters to include with their filing of the Group Form 990 Return the enclosed information as
shown on the completed annual report for the fiscal year ending June 30, 2003.
( ) will be filing Form 990 Return with the IRS independently. (The chapter
should consult with the ACM Controller prior to
filing this return separately. Copies of the filed
returns must also be furnished to ACM Headquarters).
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| Chapter Chair * |
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| Treasurer * |
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