Statistical Information
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Statistical Information mÊmmmmmÊSmmm&msmi Please type or print. Π Mr. Π Mrs. Π Dr. (FAMILY NAME) Mailing Address: Π Miss Π Ms. (FIRST NAME) ; : ;flll^^!:-=;:iiil|f |||i|| •I 1 illllll HP 8 ™ 1 iiiiiii lllSlli:, ;(lp|||||i||| Π Home D Work Previous .;Q Telephone: Home (AREA CODE) Office (AREA CODE) If your spouse is a please give his/her member, name and membership number: Date of Birth Office Use Only AMC MJR BEL HPt mm CSD ΡΝΤ923βΕ Sex: Π F DM (information needed for statistical purposes) TEC illllive Π I have not previously been a student affiliate. Membership: I have Π I have not previously been a menll||||||| ^^^Hf^^^^^^p^w^i^^^^ Professional Experience sftiSPi^^ Job Title —— Employer Employer City, State, Zip Nature of Business: Π Manufacturer Π Academic Π Government Π Other Inclusive Dates/Employment (PLEASE SPECIFY) (MO./YR.) Π Time Spent on Chemical Work % Work Functions Dues /Subscriptions /Divisions Π FREE DIVISION MEMBERSHIP FOR 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 1991 are $86.00. Your membership will begin at the nearest quarter and you will be billed accordingly. Those entering 1 October will be billed for the three months of the year plus the full dues for the following year (or 15 months dues) or at the new member's option may pay for the final three months of the current year only. Former members who did not resign will be assessed a $10.00 rein- statement fee. Please send no money now. Student Dues — If you are a student majoring in the chemical sciences, a 50% reduction on membership dues is available. To apply, you must be registered for at least six credit hours as an undergraduate or be enrolled as a full-time graduate student. • I am an undergraduate student enrolled as described above. CD I am a graduate student enrolled as described above. (NAME OF COLLEGE OR UNIVERSITY) National Affiliation — National Affiliates pay three-quarters dues (i.e., $64.50) 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, 23% (of the prorated amount) will be deducted from your bill. This is the portion that is alloted for C&EN. If you are eligible, please give the name of your spouse and his/her membership number on the back page. LOW MEMBER SUBSCRIPTION RATES. If you wish to subscribe to any ACS publications, please list them below. Remember, send no money now. IUPAC Affiliation wm^&^^^yvX:^ 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 $26.00 and include a subscription to Chemistry International magazine. D IUpAC Affi i iati0 n $26.00 (U.S. members only). Agreement mwumîw^ ^^)îvf>; I attest to the accuracy of information on the application. I agree to restict 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. (DATE) (SIGNATURE OF APPLICANT)
Transcript of Statistical Information
Statistical Information mÊmmmmmÊSmmm&msmiÊÊm Please type or print. Π Mr. Π Mrs. Π Dr.
(FAMILY NAME)
Mailing Address:
Π Miss Π Ms.
(FIRST NAME) ;:;flll^^!:-=;:iiil|f | | | i | | •I
1
illllll HP8™1
iiiiiii lllSlli:,
; ( l p | | | | | i | | |
Π Home D Work
Previous .;Q
Telephone: Home
(AREA CODE)
Office (AREA CODE)
If your spouse is a please give his/her
member, name and
membership number:
Date of Birth
Office Use Only
AMC MJR BEL HPt mm CSD ΡΝΤ923βΕ
Sex: Π F D M
(information needed for statistical purposes) TEC
illllive Π I have not previously been a student affiliate. Membership: I have Π I have not previously been a menll|||||||
^^^Hf^^^^^^p^w^i^^^^ Professional Experience sftiSPi ^ Job Title — — Employer
Employer City, State, Zip Nature of Business: Π Manufacturer Π Academic Π Government Π Other
Inclusive Dates/Employment
(PLEASE SPECIFY)
(MO./YR.)
Π Time Spent on Chemical Work %
Work Functions
Dues /Subscriptions /Divisions Π FREE D I V I S I O N M E M B E R S H I P F O R N E W M E M B E R S F O R O N E Y E A R ! Check here if you wish complete information.
There are four start dates for membersh ip : 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 u p o n approval of your applicat ion by the ACS Admissions Committee. Dues for 1991 are $86 .00 . Your membersh ip will begin at t he nearest quar ter and you will be billed accordingly. Those entering 1 October will be billed for t he three m o n t h s of the year plus the full dues for the following year (or 15 mon ths dues) or at the n e w member ' s opt ion may pay for the final three mon ths 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 D u e s — If you are a s tudent majoring in the chemical sciences, a 5 0 % reduct ion o n membership dues is available. To apply, you must be registered for at least six credit hours as an undergraduate or be enrol led as a full-time graduate s tudent .
• I am an undergraduate s tudent enrol led as descr ibed above. CD I am a graduate s tudent enrol led as descr ibed above.
(NAME OF COLLEGE OR UNIVERSITY)
Nat ional Aff i l ia t ion — National Affiliates pay three-quarters dues (i.e., $64.50) and likewise will receive a prorated bill based on the quarter National Affiliation begins. H u s b a n d / W i f e D u e s — If you are t he spouse of a m e m b e r receiving C&EN, 2 3 % (of the prorated amount) will be deducted from your bill. This is the p o r t i o n that is alloted for C&EN. If you are eligible, please give the name of your spouse and his/her membership n u m b e r o n the back page. L O W M E M B E R S U B S C R I P T I O N RATES. If you wish to subscribe to any ACS publications, please list t hem below.
Remember, send no money now.
IUPAC Affiliation wm^&^^^yvX:^ 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 $26.00 and include a subscription to Chemistry International magazine. D I U p A C A f f i i i a t i 0n $26.00 (U.S. members only).
Agreement mwumîw^ ^^)îvf>;
I attest to t he accuracy of information o n the applicat ion. I agree to restict for my o w n personal use all publicat ions to which I subscribe at member rates. I unders tand that membersh ip dues are payable annually unless my signed resignation is received by the Executive Director before January 1 of the year for w h i c h my resignation is to take effect.
(DATE) (SIGNATURE OF APPLICANT)
