Affiliate Membership Application

Chicago Section
American Chemical Society
7173 N. Austin
Niles, IL 60714
Phone: 847-647-8405
Fax: 847-647-8364
email: chicagoacs@ameritech.net
www.chicagoacs.org

Mr. Mrs. Dr. Miss Ms.

Last Name:_________________________First :________________Middle Initial___

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

Home Address: __________________________________
City:________________________ State:________ Zip code____________
Home phone: (_____)________________________
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Price: $15.00 per year

An affiliate membership entitles you to the benefits of the Chicago Section of the American Chemical Society. This includes a subscription to The Chemical Bulletin and the member’s $2 discount on dinners at monthly meetings. 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.