A P P L I C A T I O N
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.
PERSONAL INFORMATION:
Full Name
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
E-mail
Web
Laboratory
Facilities and
Equipment
(major items)
EDUCATION:
Institution(s)
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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:
Please
Provide
Three
DUES - $225 a year, payable October 1st. Dues are pro-rated for members joining during the year.
ENTRANCE FEES - This one-time charge of $75 covers the entrance fees 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: www.chemconsult.org.
