Future Chapter Meeting Profile Form


Please complete the entire form and click 'Submit' when finished. Your responses will be kept strictly confidential.

If you have questions about this form please contact Adrian Kosmicki in the ACR Office of Chapter and Volunteer Development at 800-227-5463, ext. 4917 or at akosmicki@acr.org.

Thank you for your participation.

Name:
Position in Chapter:
Chapter:
Meeting date(s):
Meeting Location
Site Name (i.e. Hotel or Convention Center)
City
State
ZIP Code
a. Is this a business meeting, education meeting, or both?
Business     Education     Both
b. Is there a topic for this meeting?
Yes     No
c. If "Yes," please describe.
1. What is the target audience for your meeting?
2. What size audience do you expect?
3. Will there be a separate program for residents?
Yes     No
3a. If "Yes," please describe the program.
4. Will elections be held at this time?
Yes     No
4a. If "No," when will your next elections take place?
5. Would you like the ACR to provide a speaker for this meeting as a part of the Chapter Visitation Program?
Yes     No
5a. If you have already invited someone to speak at your meeting on behalf of the ACR, please list that person's name here. An ACR staff member will follow up with him/her.
If "Yes", please complete questions 6-10. If "No", please skip to question 10.
6. What date and time would you like the speaker available?
Date
Time
7. How long would you like the speaker's presentation to be?
8. Please describe any issues currently facing your chapter that you would like the ACR speaker to know about.
9. Who should the ACR contact to confirm the engagement of a speaker?
Name
Mailing address
E-mail address
Phone number
10. Who should members contact for registration information? Is this the same contact in question 9 above? This information will be published on the ACR Web site.
Yes     No
10a. If "No," please indicate who.
Name
Mailing address
E-mail address
Phone number

Thank you for completing the Chapter Meeting Profile. You may contact Adrian Kosmicki with questions or concerns at either akosmicki@acr.org or 800-227-5463, ext. 4917.