Affiliate Membership Application

American Chemical Society
Chicago Section
American Chemical Society
1400 Renaissance Dr., Suite 312
Park Ridge, IL 60068
Phone: 847-391-9091


    [  ]   Mr.     [  ]  Mrs.        [  ]  Dr.     [  ]  Miss      [  ]   Ms.

Last Name:_________________________First :________________Middle Initial___

Please use my :   [  ]  Home     [  ]  Work   address
Company Name:________________________________________________
Street Address:_________________________________________________
City:_______________________ State:________ Zip code_____________
Office Phone: (_______)_______________________
Fax: (_____)____________________ Email:________________@__________________

Home Address: __________________________________
City:________________________ State:________ Zip code____________
Home phone: (_____)________________________
Fax: (_____)____________________ Email: ________________@_________________
Cell phone: ( _____)_________________
Price: $15.00 per year


An affiliate membership entitles you to the benefits of the Chicago Section of the American Chemical Society including the member’s $2 discount on dinners at monthly meetings.  The Section's monthly newsletter, The Chemical Bulletin, is available on line on our website.   Please return your $15 payment and this application to the Chicago Section, ACS at the address above.

NOTE:  Affiliate memership does not include voting privileges nor does it bestow any rights or benefits associated with membership to the National American Chemical Society.  It does not include a subscription to The Chemical & Engineering News.