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Ership or Dues: 4. Source of Funding (Sub-Account): 5. Summary Statement of Goals and/or Objectives of the Professional Organization: 6. Summary statement on benefits to be derived by the University through this membership or dues: 7. Other comments pertinent to this request (optional): Signature of Department Head Signature of Budgetary Head Title of Department Head Title of Budgetary Head Date Date APPROVED - DISAPPROVED APPROVED - DISAPPROVED Dean/Director Date Vice-Preside.
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