Membership form

Name:           

Address:       

Phone:           

e-mail:           

National Member                    yes no                 if yes, membership number

Local Membership                           Fall 2007 Spring 2008 Both

Suggested activities/ events you would lke to do this year:

Local membership dues are $5.00 per semester/ $10 per academic year. The local chapter will waive our local dues if students become a
national Student Affiliate of the American Chemical Society. Print off this membership form and return with payment to any of the Officers or Dr.
Draganjac.

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