American Chemical Society Office of the Treasurer 1155 Sixteenth Street, NW Washington, DC 20036 Telephone Number: (202) 452-2125 Fax Number: (202) 872-6325
Claim Report This report should include the date, time, and location of the incident; a comprehensive statement that details the events immediately before and after the occurrence; and the names, addresses and telephone numbers of those present.
Today’s Date: Department / ACS Division or Local Section: Detailed Statement:
Please send full written report to the following address: American Chemical Society Office of the Treasurer Attn: Peggy Jones 1155 16th Street, NW Washington, DC 20036 Telephone Number: (202) 452-2125 Fax Number: (202) 872-6325
Signed by: Authorized Signer (Manager, etc.) Address Line 1 Address Line 2 (Telephone Number)
