To: The Membership Activities Board/ACM-W Committee
From: The Proposed Student Chapter of the ACM-W 
Date: _____________________
Re: Petition for recognition of our Chapter to be known as
    Name_____________________________________________________________
    Address _________________________________________________________
    _________________________________________________________________
    _________________________________________________________________
    Phone _____________________ Fax ____________________________
    E-mail ___________________________________________
 
We request recognition as an official Student Chapter of the ACM-W, and approval 
of the bylaws, which are attached. Below are the names of at least two officers 
which are at this time members or are including a membership application herewith. 
  
Member No. ______________________________       Member application attached 
Name ____________________________________
Chair ___________________________________

Member No. ______________________________       Member application attached 
Name ____________________________________
Vice Chair ______________________________

Member No. ______________________________       Member application attached 
Name ____________________________________
Secretary _______________________________

Member No. ______________________________       Member application attached 
Name ____________________________________
Treasurer _______________________________

Member No. ______________________________       Member application attached 
Sponsor Name ____________________________