ACS Salutes to Excellence Request Form

Thank you for participating in the Salutes to Excellence program! Please provide us with information about your requested plaque(s) and planned event by completing this form. The ACS Committee on Community Activities will review your submission to ensure it meets the program's criteria. Allow up to four weeks to receive your plaque(s). If you have any questions, please contact salutes@acs.org.

Organization Type *

Local Section *

International Chemical Science Chapter *

Technical Division *

Regional Meeting *

National Committee *

Chair Full Name *

Chair Email Address *

Contact Full Name *

Contact Email Address *

Contact Mailing Address Line 1 *

Contact Mailing Address Line 2

Contact City or Country *

State: *

Zip Code *

Contact Phone Number *

Website

(Proposed) Date of Presentation: * +

Is this a rush order? * 🛈

No

Yes

Briefly describe the plans for your event, including the extent to which they have been implemented thus far: *

0/250 characters

Organization/Site/Person/Product Honored: *

If your awardee is a person, are they an ACS member? *

No

Yes

Achievement being recognized: *

0/100 words

Do you need to request another plaque? *

No

Yes

Organization/Site/Person/Product Honored: *

If your awardee is a person, are they an ACS member?

No

Yes

Achievement being recognized: *

0/100 words

Do you need to request another plaque? *

No

Yes

Organization/Site/Person/Product Honored: *

If your awardee is a person, are they an ACS member? *

No

Yes

Achievement being recognized: *

0/100 words

Do you need to request another plaque? *

No

Yes

Organization/Site/Person/Product Honored: *

If your awardee is a person, are they an ACS member? *

No

Yes

Achievement being recognized: *

0/100 words

Do you need to request another plaque? *

No

Yes

Organization/Site/Person/Product Honored: *

If your awardee is a person, are they an ACS member? *

No

Yes

Achievement being recognized: *

0/100 words

Photo Release Agreement

I hereby grant to the American Chemical Society, its affiliates, and licensees (collectively referred to as the “Society”), royalty-free permission, including the exclusive worldwide irrevocable rights in all languages, to reproduce in all formats, including, but not limited to print, microfilm, electronic, and/or CD-ROM, any photograph(s) submitted.

Further, I hereby waive my right to inspect or approve any copy that is used in connection with the photographs and release and discharge the Society from aby and all claims arising out of use by the Society of the photographs for the purposes described above.*

I have read the foregoing and fully understand its contents. *

Yes

Upload Photos

If possible, please upload pictures from your award presentation.

Each Photo must be submitted as a High- Resolution JPEG image. DO NOT compress or reduce the resolution of the original image. All subjects who are pictured watching or participating in a hands-on activity MUST be wearing safety googles. Photos that don’t show proper safety will not be considered.

Do you have a photo to upload *

Photo 1 *

Photo Caption *

Description *

Date of Activity *

Venue *

Name of Photographer (if the name of the photographer is not available, indicate wo should receive the photo credit) *

Upload Another Photo *

Photo 2 *

Photo Caption 2 *

Description *

Date of Activity *

Venue *

Name of Photographer (if the name of the photographer is not available, indicate wo should receive the photo credit) *