ACOFP | Student Chapter Membership Recruitment Fair Form

The Student Association of the American College of Osteopathic Family Physicians strives for 100% student membership at every College of Osteopathic Medicine. Each chapter has access to $750 annually to support membership recruitment and family medicine-related activities. For questions or assistance, please reach out to your National Student Executive Board representative or email [email protected]. Please complete the form below to share your chapter’s membership recruitment plans and support 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