Sos Complete Membership Form 09

Science One Survivors (SOS) 2009-2010 Membership Form scienceonesurvivors.blogspot.com

Please complete both sides of this form!

General Information First name: _____________________________ Last name: _____________________________________ Gender: [ ] Male

[ ] Female

UBC Student number: ____________________ (8 digits) Email: _____________________________________________________ Phone Number: ______________________________

Payment Information (please hand in your fee with this form!) SOS lifetime membership fee: $10.00 CDN

[ ] cash [ ] cheque (payable to Science One Survivors)

SOS Constitution (can be found on our website: scienceonesurvivors.blogspot.com) I have read the SOS Constitution. By signing below, I confirm that I fully understand and comply with the entire contents of the constitution.

X____________________________________ signature

Do you want a mentor? [ ] Yes [ ] No If yes, proceed to the Mentoring Program Application below. If no, don't bother.

Mentoring Program Application

(put an “x” in all the [] choices that apply or insert your info.)

1. Where are you currently living? [ ] On campus [ ] At home, _______________________ (insert name of city/town)

2. How often would you like to meet with your mentor? [ ] Once a week [ ] Once every two weeks [ ] Once a month [ ] Occasionally (when you need help with tough material) [ ] Other:________________________ 3. Would you be more comfortable with a…? [ ] Male mentor [ ] Female mentor [ ] No preference

4. Which of these subjects would want your mentor to help you with? (choose all that apply) [ ] General University Life [ ] Living on Campus [ ] Choosing Courses [ ] Physics [ ] Math [ ] Chemistry [ ] Biology [ ] English [ ] Other: ____________________________ 5. What is your academic field of interest?

____________________________________ 6. Do you know any people who were in Science One who you would like to request as your mentor? If so, please list their names here:____________________ (Note: we may be unable to comply with your request if more than one person requests the same mentor, or if s/he does not wish to be a mentor.) th

All membership forms and fees must be handed in to an SOS Executive ON OR BEFORE Thursday September 17 . (Forms will be collected at the SOS welcome back bbq on Sept 12, and after class by Shoujun or Justin on Sept 15, 16, & 17.)