MEMBERSHIP APPLICATION

®
2020 PROMOTION CODE
American Chemical Society | Member Services
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Family/Last Name _________________________________________ First Name _________________________________ Middle Initial ________

Primary Email Address ____________________________________________________________________________________________________
(Required for digital delivery of C&EN and to activate certain other member benefits )

Employer Name (Company/University) _______________________________________________________________________________________

Job Title _______________________________________________________ Job Function ______________________________________________
Employer Address (Company/University) ______________________________________________________________________________________
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MEMBERSHIP* Your membership benefits will become active the day your payment is processed. (select one) ALL PRICES BELOW ARE IN U.S. DOLLARS
 egular Member (New or Reinstating): A person who has a degree, certification, or significant
R 1 yr $175.00 __________
work history in a chemical or related sciences; or certification as a teacher of chemical science.
Prior Membership # (if returning): _______________________________________________ 2 yr $350.00 __________
Society Affiliate /Non-Scientist: A person who is not eligible to become a member of the Society
but whose major vocational effort is directly concerned with the practice of a chemical science. 3 yr $525.00 __________
Graduate Student Member:
A full-time graduate student, majoring in a chemical science or a related academic discipline.
— OR —
Regular Member/Recent Grad: A person that has received their bachelor degree within the last 12 months
and is transitioning into the workforce will receive 50% off the Regular Member Dues. $87.50 _________
Student Member/Recent Grad: A person that has received their bachelor degree within the last
12 months and is continuing on to graduate school will receive 50% off the Graduate Student Member Dues. $43.75 _________
Undergraduate Student Member:
A person working toward an undergraduate degree in chemistry or in a related academic discipline.
Without C&EN Subscription $29.00 __________
 ith C&EN Subscription
W $60.00 __________
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Technical Division subtotal (from side 2). +$__________
A Spouse of a member who is receiving C&EN may deduct the 2019 allocation Subtract $67.49 – $<________>
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Total Amount Due: __________
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 TECHNICAL DIVISIONS
First-time ACS members (including Society Affiliates) may choose up to three FREE Division memberships your first year.
Additional Divisions may be selected below and the associated dues amounts will be charged.
My 3 free Division selections: ____________________________ ____________________________ ____________________________
Write in or circle your free divisions.

10
$ 
Agricultural and Food Chemistry $12 Chemical Health & Safety $15 
Inorganic Chemistry
$14 Agrochemicals $15 Chemical Information $25 Medicinal Chemistry
$20 Analytical Chemistry $25 Chemical Toxicology $25 Nuclear Chemistry and Technology
$20 Biochemical Technology $18 Chemistry and The Law $15 Organic Chemistry
$15 Biological Chemistry $15 Colloid and Surface Chemistry $20 Physical Chemistry
$20 Business Development and $22 Computers in Chemistry $30 Polymer Chemistry
Management $20 Division of Energy and Fuels $25 Polymeric Materials: Science and
12.50
$ Carbohydrate Chemistry $15 Environmental Chemistry Engineering
$10 Catalysis Science and Technology $10 Fluorine Chemistry* $10 Professional Relations
$15 Cellulose and Renewable $15 Geochemistry $105 Rubber
Materials $20 History of Chemistry $15 Small Chemical Businesses
$25 Chemical Education $14 Industrial and Engineering
Chemistry Technical Division subtotal $______
(carry over to side 1)
*Fluorine Chemistry does not participate in first year free offer.

ACADEMIC TRAINING
Name of College or Title of Degree(s) Month/Year
University (including City and Curriculum Major Received or Expected Degree Received
current enrollment) State/Country A.S., B.S., M.S., Ph.D. or Expected
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________

WORK HISTORY If your degree or certification is not in Chemistry or a related STEM field, please provide the following:
Company/University Name Service Year(s) Job Title City/State/Country
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________

INDUSTRY CODE/ NATURE OF BUSINESS

Which best represents your employer’s industry/nature of business.

1 Independent Laboratory K Government Y3 Environmental/Water Y8 Manufacturer Other:
2 Independent Consulting L Public Utility/ Y4 Food/Beverage/Flavors ________________________
3 Hospital/Clinic Transportation ________________________
Y5 Industrial Chemicals
66 Academic Institution M Retail/Wholesale Trade ZZ Other:
J Engineering/Construction Y1 Pharmaceutical Y6 Agricultural ________________________
Firm Y2 Biotech/Life Sciences Co Y7 Petrochemical ________________________

We nominate the following candidate to be considered for membership in the American Chemical Society (ACS) and verify that this
candidate, in accordance with ACS Bylaw I, Section 3, meets the qualifications for consideration for membership.
ACS Member: ACS Member:
_________________________________________________ __________________________________________________
Kate Fryer, Executive Vice President, Membership Division Brian M Mathes, Chair, Membership Affairs Committee

MEMBER-ELECT (NOMINEE) AGREEMENT

I attest to the accuracy of the information on the application. I agree to restrict for my own personal use all publication benefits to
which I subscribe at member rates. I understand that membership dues are payable annually unless my signed resignation is received
by the Executive Director of the Society prior to the end of the 12-month period for which dues have been paid.
Signature of Applicant X ___________________________________________________________ Date ____________________

*Includes a small allocation for Division funding. Members: 2020 $71.25 allocated to C&EN. 20AppF