Application for Membership        Association of Analytical Chemists (ANACHEM)

Name ________________________________________________________________________

 Home Address ________________________________________________________________

Business Address ________________________________________________________________

Home Phone ___________________________________ Work phone _____________________

e-mail_________________________________________ Fax ____________________________


Preferred Mailing Address        Home___ Business____

Educational Background ___________________________________________________________

____________________________________________________________________________

Current employer ________________________________________________________________

____________________________________________________________________________

Technical Society memberships _____________________________________________________  

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Circle area(s) of interest. A.   Atomic Spect.;   B.   MS.;   C. NMR;    D. Infrared Spect.;
E.   Fluorescence;   F.   UV-Visible Spect.;   G.   X-ray;    H:   GC;   I.   HPLC;   J.  TLC;.
K.   Thermal Analysis;   L.   Electrochemistry;   M. Other _______________

Signature _______________________________________ Date ________________

Print and complete the membership application and mail to the address below. Send no payment. Current dues are $25.00, full member; $10.00 students and retirees. You will be notified regarding dues and membership status ASAP.  

Mail to: Wayne Jiang, 47213 Scarlet Dr.  S,  Novi,  MI 48374