American Chemical SocietyBSS use only: Job#:
SPECIAL LIST ORDER FORM –Divisions, Local Sections, & Regional Mtgs
Page 1(Version 10A)Staff Approval Code:
Today’s Date: Need by Date: . (Min. 2 weeks/10 working days required)
Person Placing Order:Name: . Phone: . Email:
Type in shaded area below; press ENTER key for next line; TAB to go to section on right or click on shaded area.
Ship To: Bill To:
Data Request Order FormVersion Y111300
Name:
Address:
Address:
Address:
Phone:
Email:
.
.
Data Request Order FormVersion Y111300
All text files are sent via email or FTP;
Data Request Order FormVersion Y111300
Via EMAIL; give Email Address
.
FTP: give FTP Address.
Username: .
andPassword: .
Note: staff orders are sent via email only.
Data Request Order FormVersion Y111300
NOTE: you will be invoiced for EACH list; charges: $.01 per name for text file, with a minimum charge of $25.00 for each list .
FILE FORMAT / OUTPUT(check only 1 format; submit another form for each different format, except for counts).
Data Request Order FormVersion Y111300
TEXT file; default is in bold; applies if no box is checked
comma delimited
TAB delimited
Special List Order FormVersion 10A
FILE LAYOUT for text files: the Standard layout is the default: Member ID, Prefix, First Name, Last Name, Preferred Address.
Note:
Check box if you want a CUSTOM LAYOUT; specify layout in the Special Instructions section.
Check box to ADD EMAILS to your list; by checking this box, you agree to abide by the email guidelines; emails will not be provided for those who have email blocks on their records; we will notify you if emails are denied.
Enter nameAND 3-letter code Div code D or Loc Sec code L.
AND check appropriate box: ifDivision orLocal Section or Regional Mtg
and give requesting Officer Name: Officer Title: . If different from Person Placing Order.
SPECIAL INSTRUCTIONS (REQUIRED) – complete both sections:
1) give the PURPOSE for requesting this list: ;
2)in your own words, write exactly what you want, e.g. “all members plus society affiliates of D526 and include members with promo blocks.” On the following pages, you must still check which automatic settings you want to change, if any.
.
Special List Order FormVersion 10A
To fill orders from another Local Section, you must have approval from the officer of that Local Section.
LocSec Officer approval was obtained and is attached or forthcoming; for Local Section requests, prior approval by Local Section officer must be received (fax, mail, email) by ACS Staff for this request to be approved:
Special List Order FormVersion 10A
Note: When you submit this form, you acknowledge and agree that data provided may be used only once for the purpose stated, and may not be retained, shared, or duplicated in whole or in part. This list is for ACS division, local section, or regional mtg purposes only, including any co-sponsored event. If the Local Sec list is for a non-ACS group’s purpose or use, write Julia , or for outside Division list use, email . If you did not make appropriate changes on the form, the automatic default settings will apply. Your request will not be processed unless you receive prior approval from appropriate staff.
LAST STEP:rename this form, save it on your computer, and send it as an email attachment TO: Div Requests: ; Local Section Requests: ; Regional Mtg Requests: as directed. Questions?, or 202-872-4557 for Divisions and Local Sections.Page 2 (click to return to )
MEMBER SELECTIONSPage 2
Special List Order FormVersion 10A
Automatic default settings are in bold. Use the check boxes or enter text as requested to change the defaults.
Promo Block Code is for those people who do notwantto receive promotional mailings;see REQUIRED area.
I need to include those members who have a promo block on their records. In the highlighted area, write why you need to override the Promo Blocks. We will let you know if your request is denied.
Email Block Codeis for those who do not want emails. [Emails are included in suppression files.]; see REQUIRED area.
I need to include emails of those members who have email blocks on their records. In the highlighted box, write why you need to override the email blocks. We will let you know if your request is denied.
REQUIRED – if you checked either or both boxes above, you must give your purpose for overriding the Promo Block Code and/or Email Block Code:
Membership Type = Regular, Affiliates only [Note: Deceased or resigned members are not included. To change this default, check all that apply:
Regular Members
Emeritus Members
Affiliates
Suppression File (includes deceased & resigned members and all available and bad addresses in database);
includes emails with blocks; use this selection for matching/checking purposes only; do notuse for mailing list.
Payment Status = ALL. To change this default, check box(es) you want to INCLUDE:
Special List Order FormVersion 10A
Paid
Partial Paid
Free
On Credit
Grace
Unpaid
Special List Order FormVersion 10A
Full file of my selections is the default.
Check box if you want nth select (partial file) and give maximum file quantity here .
Merge/Purge is the default (there are no duplicate listings in the file).
Check box if you do NOT want Merge/Purge set (in other words, you want duplicate listings in the file). For example, if customers are members of more than one division, there might be duplicate listings.
ZIP code order is the default; you can change the sort:
Alphabetical order (default is last name) Special sort (give details in Special Instructions on page 1)
Geography = ALL. To change this default, check all that apply:
US domestic Canada Foreign / International or selections below (use 2-or 3-letter abbrev.)
States . Canadian Provinces . Foreign Countries .
Bad Addresses are NOT included, except in Suppression files and when specifically requested in Special Instructions.
REGIONAL MEETING REGIONS
Central: L200, 227, 202-204, 206-213, 220, 233, 224, 231, 238, 225, 215, 241, 219, 221, 232, 223, 299, 599.
Great Lakes: L539-40, 501-2, 556, 506, 230, 536-7, 510, 520, 512-13, 515,518,239,521,547,240,532,243,299,599.
Middle Atlantic: L122, 300, 120, 301, 302, 108, 303, 314, 304, 305, 306, 308, 121, 307, 315, 226, 199, 299, 399.
Midwest: L500, 505, 508, 509, 520, 526, 514, 517, 548, 523-525, 527, 538, 530, 531, 535, 599.
Northeast: L100, 101, 102, 103, 116, 104, 114, 105, 106, 107, 109, 110, 115, 244, 111, 118, 112, 113, 119, 199.
Northwest: L643, 641, 608, 609, 610, 612, 617, 620, 621, 622, 624, 629, 637, 639, 599, 699.
Special List Order FormVersion 10A
Page 3(click to return to )
Special List Order FormVersion 10A
Divisions & Local Sections ListsPage 3
Special List Order FormVersion 10A
REGIONAL MEETING REGIONS (continued)
Rocky Mtn: L602, 557, 641, 558, 624, 632, 639, 599, 699.
Southeast: L400, 402, 405-407, 217, 410-414, 218, 245, 417, 234, 228, 419, 229, 235, 454, 422, 423, 425-427,236-237,
420, 431, 445, 435, 434, 409, 416, 246, 205, 442, 444, 299, 499.
Southwest: L403-4, 541, 446, 450-3, 436, 419, 401, 543-546,430, 549,550,551, 559, 433, 447-8, 437, 538, 553, 499, 599.
Special List Order FormVersion 10A
Western: L601, 644, 602, 611, 616, 623, 626, 627, 607, 628, 632, 633, 600, 699.
DIVISION REQUEST: members of these/this Division(s): check all that apply below:
Special List Order FormVersion 10A
AGFD--D501
AGRO--D523
ANYL--D502
BIOT--D519
BIOL--D503
BMGT--D508
CARB--D504
CELL--D505
CHAL--D532
CHED--D506
CHAS--D529
CINF--D507
CATL--D536
TOXI--D534
COLL--D509
COMP--D510
ENVR--D511
FLUO--D513
FUEL--D514
GEOC--D530
HIST--D515
I&EC--D516
INOR--D517
MEDI--D518
NUCL--D520
ORGN--D521
PETR--D524
PHYS—D525
POLY--D526
PMSE--D522
PROF--D527
SCHB--D531
Special List Order FormVersion 10A
LOCAL SECTION REQUEST: members of these/this Section(s)
Akron, L200
Alabama, L400
Alaska, L643
Ames, L500
Auburn, L402
Baton Rouge, L403
Binghamton, L100
Brazosport, L404
California, L601
Calif Los Padres, L644
Carolina Piedmont, L405
Central Arizona, L602
Central Arkansas, L541
Central Mass, L101
Central N Carolina, L407
Central NM, L557
CentrlOhioValley, L227
Central PA, L122
Central Texas, L446
Central Utah, L641
Central Wisconsin, L539
Chattanooga, L217
ChemSoc of Wash,L315
Chicago, L501
Cincinnati, L202
Cleveland, L203
Coastal Georgia, L410
Colorado, L558
Columbus, L204
CT Valley, L102
Cornell, L103
Corning, L116
Dallas Ft Worth, L452
Dayton, L206
Decatur-Springfld, L540
Delaware, L300
Detroit, L207
East Centrl Illinois, L556
East Tennessee, L218
East Texas, L451
Eastern NC, L412
Eastern NY, L104
Erie, L208
Florida, L413
Georgia, L414
Greater Houston, L436
GreenMountain, L114
Hampton Roads, L245
Hawaii, L608
Heart O'Texas, L453
HuronValley, L220
Idaho, L609
Illinois Heartland, L518
Illinois-Iowa, L502
Indiana, L233
Indiana-KYBorder, L209
Inland Northwest, L610
Iowa, L505
Jacksonville, L417
Joliet, L506
Kalamazoo, L230
KanawhaValley, L224
Kansas City, L508
KansasState Univ, L509
KentuckyLake, L234
Lacrosse Winona, L537
Lake Superior, L510
LehighValley, L120
Lexington, L228
Louisiana, L419
Louisville, L229
Maine, L105
Mark Twain, L520
Maryland, L301
Memphis, L235
MichiganState Univ, L231
Mid-Hudson, L106
Middle Georgia, L454
Midland, L211
Milwaukee, L512
Minnesota, L513
Mississippi, L422
Mobile, L423
Mojave Desert, L611
Mo-Kan-Ok, L526
Monmouth Cty, L302
Montana, L612
N Alabama, L425
N Ctrl Oklahoma, L543
Nashville, L236
NE Georgia, L427
NE Oklahoma, L544
NE Wisconsin, L515
Nebraska, L514
New Haven, L107
New York, L108
North Carolina, L426
North Jersey, L303
Northeast Tenn,L237
Northeastern, L109
Northeastern IN, L238
Northeastern Ohio, L212
Northern New York, L110
Northern W. Virginia, L225
Northwst Cntrl Ohio, L210
Norwich, L115
NW Louisiana, L401
OceanCountyT, L314
Oklahoma, L545
Ole Miss, L420
Omaha, L517
OrangeCounty, L616
Oregon, L617
Orlando, L411
OuachitaValley, L430
Ozark, L548
Panhandle Plains, L549
Penn-Ohio Border, L213
Penn-York, L244
Pensacola, L431
PermianBasin, L550
Philadelphia, L304
Pittsburgh, L215
Portland, L620
Princeton, L305
Puerto Rico, L445
Puget Sound, L621
Purdue, L239
Red RiverValley, L521
Rhode Island, L111
Richland, L622
Rio GrandeValley, L559
Rochester, L118
Rock River, L547
S Carolina, L435
S Central Missouri, L525
Sabine-Neches, L433
Sacramento, L623
SaltLake, L624
San Antonio, L447
San Diego, L626
San Gorgonio, L627
SanJoaqnVally, L607
SantaClaraVlly, L628
Savannah River, L434
Sierra Nevada, L629
SiouxValley, L524
South Florida, L409
South Jersey, L306
South Plains, L551
South Texas, L448
SoutheastrnPA,L308
Southern AZ, L632
Southern Calif, L633
Southern Illinois, L527
SouthernIndiana,L241
SouthernNevadaL600
St JosephValley, L240
St Louis, L523
SusquehnaVally,L121
SW Georgia, L416
SW Louisiana, L437
Syracuse, L112
TampaBay, L406
Texas A&M, L450
Toledo, L219
Trenton, L307
Tulsa, L546
Univ of AR, L538
WakarusaValley,L530
Univ of Missouri, L531
UpperOhioVally, L221
UpperPeninsula, L532
US Terr unasgn, L999
Virginia, L246
VA Blue Ridge, L205
WabashValley, L243
Wash-IdahoBrdr,L637
WestrnCarolinas,L442
Western CT, L113
Western MD, L226
Western MI, L232
WesternNY, L119
Wichita, L535
WichitaFlsDncn, L553
Wilson Dam, L444
Wisconsin, L536
Wooster, L223
Wyoming, L639
Dist I-unassgn, L199
Dist II-unassgn, L299
Dist III-unassgn, L399
Dist IV-unassgn, L499
Dist V-unassgn, L599
Dist VI-unassgn, L699
LS list: 09/17/10
Done? Click to return to LAST STEP on Page 1.