AMERICAN CHEMICAL SOCIETY · 1155 Sixteenth Street, N.W., Washington, D.C. 20036/(202) 872-4600
ACS Membership Application 1982
Applicant Mr., Mrs. (Name) Dr., Miss, Ms.
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Mailing Address Number and Street
Telephone Zip C o d e / C o u n t r y
State
City
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Academic Training Name of College or University (Including current enrollment)
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Years of Attendance
Title of Degree(s) Received or Expected
Date Degree Received or Expected
Courses Completed Please list completed courses (by title) in the chemical sciences (Attach separate sheet or transcript if more space is needed.) Not required of those with a bachelor's, masters or doctor's degree in a chemical science or those with a doctor's degree in a science closely related to chemistry with demonstrated significant experience in the practice of a chemical science. 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. Semester Hours
Course Title
Course Title
Semester Hours
Course Title
Semester Hours
Nomination Nomination by two ACS members (not necessary for former members; student affiliation does not constitute former membership). If this presents difficulty, please contact the Washington office. for membership in the American Chemical Society.
We recommend . (Name of Applicant)
ACS Member: (Signature)
(Printed Name)
ACS member: (Printed Name)
(Signature)
This space for use of: ADMISSIONS COMMITTEE
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Local Section/Division
Statistical Information
Office Use Only AMC
Mr.. Mrs (Name) Dr
Miss. M s
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Mailing Address Number and Street
CSD PIMI.
City
State
Ζ·ρ Code/Country
Date of Birth
CLD_ Sex
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Previous Membership I have
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have not
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previously been a member
I have ' !
have not
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previously been a student affiliate
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Professional Experience Employer
Job Title
Functions
°c Time on Cnermcai Work
Inclusive Dates of Employment (Mo & Yr ι
Dues There are four start dates for m e m b e r s h i p 1 lanuarv 1 April 1 lulv and 1 ( )i toher U r an· an\n»us t< » begin \our membership as soon as possible and will therefore enroll vou immediatelv upon approval b\ t h r Admissions iΊ»ninnttt-t· hues lor 1(>SJ are $58 (X) Your m e m t x ' r s h i p will begin at the nearest quarter «ind vou will be billed a u o r d m g k / ' Λ Ϊ Ν · \,.t.'st>
National Affiliation National affiliates pav three-quarters dues (ι e S Π .">()) and likewise will reteive a p f M l e d lull k i s e d ..n the quarter national affiliation tx»gms
Husband /Wife Dues If vou
