2019 WCC Membership Form
Please complete all the required information and submit your membership dues via the PayPal link available on our website (
www.pghWCC.org
).
* Required
First Name
*
Your answer
Last Name
*
Your answer
Street Address 1
*
Your answer
Street Address 2
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Email Address
*
Your answer
Phone
*
Your answer
Professional Affiliation
*
Please enter the name of where you work or attend school currently
Your answer
Position
*
What is your position with your company or at what stage in your education are you as a student
Your answer
Please select type of membership
*
Student ($5)
Professional ($15)
I am currently a member of the American Chemical Society
*
*membership in the ACS is not required for WCC membership
Yes
No
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