Instructions: 1. Complete the FORM below.2. Dues are voluntary. If you pay voluntary dues, PRINT the form and mail it with your check for $15 (payable to Portland Section ACS) to: Portland Section American Chemical Society Attn: Bernard Carlsen/Martha Dibblee PO Box 1741 Portland OR 97207-17413. Don't forget to click the BLUE Submit button whether or not you print the form to use as in invoice for payment. 4. We do not share email addresses with anyone. To ensure receipt of email notices include "firstname.lastname@example.org" in your list of email addresses.
Membership cards are available for those who want them. Please email email@example.com if you want a membership card. Your membership card will be mailed to the address provided below.______________________________________________________________
I hereby apply for Local Section Affiliate Membership:
Received by ______________________________________________
Date____________________ Amount $____________________