Application

Individuals not now members of the Association but currently engaged in consulting practice as chemists or chemical engineers, are encouraged to apply for membership. Please complete each section of the form below. A blank entry will signify that this item does not apply to applicant.

DUES – $75 a year, payable October 1st.
ENTRANCE FEES – The one-time charge of $25 covers the entrance fees and first year dues for both regular and affiliate members. This fee includes a copy of the Constitution and By-Laws and the regular member’s individual web directory page on our searchable web site directory.

PERSONAL INFORMATION:


Full Name (required)

Home Address

City

State

Country

Postal Code

Home Phone

CONSULTING PRACTICE OR COMPANY:


Starting Date of Consulting

Name of Practice

Address

City

State

Country

Postal Code

Phone

Fax

Email (required)

Web

Laboratory, Facilities and, Equipment
(major items)

Education:


Institution(s), Location(s), Date(s), Degree(s)

Experience:


Organization(s), Location(s), Date(s), Position(s)

PATENTS AND PUBLICATIONS:


SOCIETY MEMBERSHIPS:


DIRECTORY LISTINGS:


PROFESSIONAL CERTIFICATIONS AND LICENSES:


PROFESSIONAL AND TECHNICAL REFERENCES:


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