CHINESE AMERICAN CHEMICAL SOCIETY MEMBERSHIP FORM

( To input Chinese without any software click here .)

New Application	Renewal	Infomation Update
First Name: Last Name: 中文姓名:(Optional)
Affiliation/Title:
Email:
Phone Number:
Degree:
Field:
School:
Mailing Address:
City: State: Zip Code:

Current Job Function:	Academia	Industrial R&D	Consulting	Sales/Marketing
	Manufacturing	Management	Engineering/Design	Computer Application
	Other (specify):
Please indicate your interests in the following committees:
Membership Committee	Newsletter Committee	Website Committee	Program Committee	Public Relationship Committee
Recommended by: (Optional)
I hereby apply for membership to the CACS as a:
Regular Member ($20/year)	Student Member ($10/year)	Special Member($100/year)	Life Member ($200 in one payment)	Corporate Member ($850/year)
Additional Contributions: (Tax Deductible)
Please make check payable to CACS or Chinese American Chemical Society and mail to: Dr. Xiaoqiu Wu, CACS Tristate Chapter Treasurer, P. O. Box 786, Edison, NJ 08818 To pay the membership fee by credit cards, please click the button below:

Additional Contributions by credit cards,please click the button: