American Chemical Society
1999 MEMBERSHIP APPLICATION
PO Box 82229, Columbus, OH 43202-2229 Upon approval, please activate my ACS Membership including my subscription to Chemical & Engineering News. Also, sign me up for my year of ACS Local Section membership and free Division membership. DMr.
DMrs.
DDr.
DMiss
DMs.
Last Name
Middle Initial
.First Name.
Mailing address for delivery of C&EN and membership material: D Home D Work Company Name
,
Street Address. City
_Zip
. State
Home#
Office # (AREA CODE)
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E-mail_ (AREA CODE)
For more information: CALL (800) 333-9511 or (614) 447-3776 FAX (614) 447-3891 E-MAIL
[email protected] IMPORTANT NOTE: You must complete the entire application. Please do not leave out information. Incomplete information will slow down your admissions process. MEMBERSHIP CATEGORIES
DO NOT SEND ANY MONEY NOW. Upon approval you will be invoiced at the appropriate rate. See dues rates on the back of this application. Please check only one: D Regular Member D Student Member
D National Affiliate D Member Reinstatement Membership Number:_ ACADEMIC TRAINING
Name of College or University (Including current enrollment)
City and State
Curriculum Major
Date Degree Received or Expected
Title of Degree(s) Received or Expected B.S., M.S., Ph.D.
PLEASE NOTE: If you have less than a B.S. degree in chemistry, chemical engineering, or a chemistry-centered science but have significant achievement in the chemical sciences, you may be required to fill out a supplementary information form.
ACS Approved School: D Yes D No
PROFESSIONAL EXPERIENCE (Required)
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.
Job Title . Employer Employer City, State, Zip .
Racial-ethnic origin (please check one only) : D White (Caucasian)
D American Indian or Alaskan Native
Inclusive Dates/Employment (MO./YR.)
D Black or African American D Native Hawaiian or Pacific Islander
Time Spent on Chemical Work
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Π Asian
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Local Section/Division Commission Claim
DUES INFORMATION
IUPAC AFFILIATION
Dues are prorated on a quarterly basis. Upon approval of your application by the ACS Admissions Committee, your membership will begin during the nearest quarter. Please send no money now. Student Discount A member who is a student, under graduate 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 within one year from the date of graduation to receive a half-year waiver of member dues. National Affiliation National Affiliates pay three-quarters dues 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 Chemical & Engineering News, you may deduct a portion of your dues allotted for C&EN. Please request this deduction on your dues bill. MEMBER CATEGORIES
MEMBERSHIP START DATES
PRORATED DUES
Member
$105.00
January 1
100% 1999 dues
Student Member
$52.50
April 1
75% 1999 dues
National Affiliate
$79.00
Julyl
50% 1999 dues
October 1
25% 1999 dues + 100% 2000 dues
• IUPAC Affiliation $29.00 (U.S. members only). 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 Affiliates dues for ACS members residing in the U.S. are $29.00 and include a subscription to Chemistry International magazine. NOMINATION
We nominate this Applicant for membership in the American Chemical Society according to the Constitution and Bylaws. Π Check here and submit your application if you want ACS to assist you in finding nominator (s). 1. ACS Member:
Signature
Printed Name
Membership #
AMERICAN CHEMICAL SOCIETY DIVISIONS
Thirty-two divisions offer membership free for first-time members. Check the ACS Division of Your Choice D Agricultural and Food D Fertilizer and Soil Chemistry Chemistry D Fluorine Chemistry D Agrochemicals D Fuel Chemistry D Analytical Chemistry D Geochemistry D Biochemical Technology D The History of Chemistry D Biological Chemistry D Industrial and Engineering D Business Development and Chemistry Management D Inorganic Chemistry D Carbohydrate Chemistry D Medicinal Chemistry D Cellulose, Paper and Textile D Nuclear Chemistry and D Chemical Education*** Technology D Chemical Health and Safety D Organic Chemistry D Chemical Information D Petroleum Chemistry D Chemical Technicians D Physical Chemistry D Chemical Toxicology D Polymer Chemistry D Polymeric Materials: Science (probationary) * D Chemistry and the Law and Engineering D Colloid and Surface D Professional Relations Chemistry D Rubber Division** D Computers in Chemistry D Small Chemical Businesses D Environmental Chemistry* * This division does not offer free membership for new members. ** Send dues payments to: Rubber Division, University of Akron, Akron, OH 44325. ***Journal of Chemical Education not included.
2. ACS Member: Signature
Printed Name
Membership #
AGREEMENT
I attest to the accuracy of information on the application. I agree to restrict for my own personal use all publica tions 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
