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Chiro Club Sponsorship
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First Name:
Last Name:
Email Address:
Phone Number:
School Name:
Year In School:
Freshman
Sophomore
Junior
Senior
Graduate
I am an Advisor/Mentor
Other
If Other, please explain:
Chiropractic Club Information
Are you part of an existing club?
Are you part of an existing club?
Yes
No
Club Name:
Faculty Advisor Name:
Funding Amount Requested - Up to $300
A brief explanation of how the funds will be used?
Submit
