polyP

    Home
    Contact Us
    Organization Chart
    Site Map/Search

Registration Form

Use this form if you wish to join the Division of Polymer Chemistry, Inc.

To join the Division as a Member, you must be a Member of the American Chemical Society (or a national Affiliate). To join as a Student Member, you must be a Student Member of ACS. If you are not an ACS member, you may join as an Affiliate.


Name
E-mail (for POLY electronic discussion list)

Affiliation

Address

City
State
Postal Code
Country

Telephone Number
Fax Number
Membership Category (select one)
ACSMembers
Member (ACS Member) - $30
Student Member (ACS Student) - $20
Non-ACS Members
Affiliate Member - $50
Student Affiliate - $50
Additional Fees
Postage Surcharge, $10
   (Required for Overseas Mailing)
airmail delivery, of Polymer Preprints
   (Optional, $60 per year)
Payment Method (select one)
check (mail in)
charge my: 		Credit Card Information

Cardholder's Name
   
Card Number             Exp. Date

Any special comments for or about the Division
POLY Sponsor (optional)
 Membership Campaign CODE (optional)

Choosing Reset Form will erase all of your entries and allow you to start over.

Choosing Submit Registration will allow you to check and process your registration.
Other Registration Methods:
If you have concerns about sending credit card information across the Internet or you wish to pay by check: fill out the electronic form; leave the credit card information blank; press the "Submit" Button (so we get the information electronically); print out the form and mail it to the Division along with your check.
  Home | Contact Us | Site Map Division of Polymer Chemistry, Inc. - All rights reserved Contact Frank Blum with questions or comments about this web site
Number of accesses since 2.18.98: 23419