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MEMBERSHIP APPLICATION by CREDIT CARD


Membership dues are $75 for the period from the first of June through the end of May each year. If applying during November through May, your initial dues are only $37.50.Use this form to pay the appropriate amount by credit card.


First Name on Credit Card:


Last Name on Credit Card:


Applicant Name (if different):


Applicant's Title:

 Company:


Company Street Address:


City:


State and Zip Code:


Work Phone:


Type of Company
(Integrated Major, Chemical Trading, Consulting, etc.):


Your Responsibilities:


Briefly explain your reasons for applying for membership:


Exact Name for your badge:


Exact Company Name for your badge: