Become a Portland Section ACS Affiliate
To become a Portland Local Section American Chemical Society (ACS) Affiliate complete the form below.
A Portland Local Section ACS Affiliate:
Is welcome at all Portland Section meetings, activities and events
Receives all Section notices
May pay voluntary dues of $15
May neither vote for nor hold an elective position
May participate in committees

Dues are voluntary. If you choose pay dues, there are two options.
1. You may print this form and mail a copy of the printed form (which serves as an invoice) with your check for $1 (payable to PORTLAND SECTION ACS) to:
Portland Section American Chemical Society
Attn: Portland Section Treasurer
PO Box 1741
Portland OR 97207-1741
2. You may pay by credit card at http://bit.ly/SQUOSSF (scroll to lower half of page).

3. We do not share email addresses with anyone.

4. To ensure receipt of email notices (from ACS MagnetMail) include "mgdibblee@icloud.com" in your list of email addresses.

4. ACS Affiliate cards are available at a Section meeting.

5. Entries to this form are automatically sent to Portland Section ACS.
______________________________________________________________

I hereby apply for PORTLAND LOCAL SECTION ACS Affiliate Membership:

FIRST NAME
Your answer
LAST NAME and SUFFIX if any
Your answer
PRIMARY COMPANY NAME
Your answer
PRIMARY DEP'T NAME & MAIL STOP or APT #
Your answer
PRIMARY MAILING ADDRESS
Your answer
PRIMARY CITY
Your answer
PRIMARY STATE
Your answer
PRIMARY ZIPCODE
Your answer
PREFERRED EMAIL ADDRESS
Your answer
PREFERRED PHONE NUMBER
Your answer
EDUCATION & MAJOR
Your answer
FOR TEACHERS: GRADE LEVEL
VOLUNTARY DUES
Dues are voluntary. If you choose to pay, DUES are $15. You may pay by credit card online at http://bit.ly/SQUOSSF or by check. if you pay online send an email to bcarlsen@reed.edu. If you submit a check to the Section, print two (2) copies of this form and keep one copy as your record of payment. You also may use a credit card to pay dues at a Section meeting.
AMOUNT ENCLOSED
Print and enclose a copy of this form if you submit a check for voluntary dues payment.
Your answer
CHECK NUMBER
Print this form form for your records.
Your answer
If you choose to pay $15 dues, this form is your Invoice. PRINT this form before clicking the submit button
PORTLAND SECTION USE ONLY

Received by ______________________________________________

Date____________________ Amount $____________________

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