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American Chemical Society 1996 Membership Application
H55 Sixteenth Street, NW, Washington, DC 20036
An Invitation The American Chemical Society, the world's largest scientific organization, invites you to join in membership with more than 150,000 other chemists, chemical engineers, and scientists in allied fields. We hope this application will provide the opportunity for you to take advantage of the many benefits ACS offers to its members. Please type or print. ϋ
Mr.
D Mrs.
D Dr.
D Miss
D Ms. (FAMILY NAME)
(FIRST NAME)
(MIDDLE NAME)
Mailing Address: D Home D Work
Telephone: Home
Office (AREA CODE)
Fax (AREA CODE)
Previous Membership: I I I have I I have not previously been a member. If your spouse is a member, please give his/her name and membership number
(AREA CODE)
I I I have
I I have not
previously been a student affiliate.
Academic Training Name of College or University (Including current enrollment)
ACS Approved School
D Yes
Curriculum Major
City and State
Title of Degree(s) Received or Expected B.S.,M.S., B.S., M.S., Ph.D.
Date Degree Received or Expected
D No
Professional Experience Job Title
Employer
Employer City, State, Zip
Inclusive Dates/Employment (MO./YR.)
Nature of Business:
I I Manufacturer
Academic
__ Government
__ Other
Π Time Spent on Chemical Work
%
(PLEASE SPECIFY)
Work Functions
Demographic Information The following voluntary information is collected for demographic purposes only. Individual confidentiality will be maintained although statistical data may be published in the aggregate. Information provided will not be used or considered in connection with any decision regarding membership. Racial-ethnic origin:
White (Caucasian)
I I Asian (including Pacific Islanders)
I—I Hispanic (including persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish origin or culture, regardless of race)
LJ Other
Date of Birth
MG BC MJR DEL HDL MED
LJ Native American (including Alaskan natives)
D African American (Black)
Sex: Office Use Only ASD ΡΝΪ
D F
D M Local S e c t i o n / D i v i s i o n C o m m i s s i o n C l a i m
This space for use of ADMISSIONS COMMITTEE
0719B
TEC
1
4WF2-96
Courses Completed NOT REQUIRED of those with α degree in chemistry, chemical engineering,
or a closely related
science.
Please list completed courses (by title) in the chemical sciences. (Attach separate sheet or transcript if more space is needed). Quarter hour credits should be multiplied by two-thirds. If school did not use a credit hour system, please estimate credits on basis of 15 lecture clock hours or 45 laboratory clock hours as equivalent to one semester hour credit. Course Title
Semester Hours
Semester Hours
Course Title
Semester Hours
Course Title
Dues/Subscriptions/Divisions D MOST DIVISIONS OFFER FREE MEMBERSHIP TO NEW MEMBERS FOR ONE YEAR! Check here if you wish complete information. There are four start dates for membership: 1 January, 1 April, 1 July, and 1 October. We are anxious to begin your membership as soon as possible and will therefore enroll you immediately upon approval of your application by the ACS Admissions Committee. Dues for 1996 are $99.00. Your membership will begin at the nearest quarter and you will be billed accordingly Those entering 1 October will be billed for the three remaining months of the year plus the full dues for the following year (or 15 months dues) or the new member may pay for the final three months of the current year only. Former members w h o did not resign will be assessed a $10.00 reinstatement fee. Please send no money now. Student Discount—A member who is a student, undergraduate or graduate, majoring in a chemical science or a related academic discipline, shall be entitled to a discount of one-half of the membership dues so long as the student certifies registration for at least six credit hours as an undergraduate or is doing full-time graduate work. Six Month Dues Waiver for New Graduates—A person graduating with a bachelor's degree in a chemical science may apply for membership, and receive a half-year waiver of member dues to begin during any quarter up to one year from the date of graduation. National Affiliation — National Affiliates pay three-quarters dues (i.e., $74.00) and likewise will receive a prorated bill based on the quarter National Affiliation begins. Husband/Wife Dues — If you are the spouse of a member receiving C&EN, a portion of your dues that is allotted for C&EN may be deducted. If you would like to request the deduction, please provide the name of your spouse and his/her membership number on page one. This savings will be reflected on your dues bill. LOW MEMBER SUBSCRIPTION RATES. If you wish to subscribe to any ACS publications, please list them below.
Remember, send no money now.
IUPAC Affiliation The International Union of Pure and Applied Chemistry (IUPAC) offers individual affiliation to members of national chemical societies. Recognized by all the sciences and by the national level academies of science as the international representative body for chemistry, IUPAC is the authority on chemical nomenclature, terminology, symbols, atomic weights, and related topics. IUPAC Affiliate dues for ACS members residing in the U.S. are $ 29.00 and include a subscription to Chemistry International magazine. D I U p A C A f f i l i a t i o n $29.00 (U.S. members only).
Nomination Nomination by two ACS members is required by ACS Bylaws. If this presents difficulty, please call the Admissions Office at 202/872-4567 for assistance. NOTE: Such nomination is not necessary for former members. Student affiliation does not constitute membership. We recommend
.
for membership
in the American
Chemical
Society.
(NAME OF APPLICANT)
ACS Member:
_____ (SIGNATURE)
(PRINTED NAME)
(SIGNATURE)
(PRINTED NAME)
ACS Member:
Agreement I attest to the accuracy of information on the application. I agree to restrict for my own personal use all publications to which I subscribe at member rates. I understand that membership dues are payable annually unless my signed resignation is received by the Executive Director before January 1 of the year for which my resignation is to take effect. (SIGNATURE OF APPLICANT)
(DATE)
