To join the Division as a Member, you must be a Member of the American Chemical Society (or a national Affiliate). To join as a Student Member, you must be a Student Member of ACS. If you are not an ACS member, you may join as an Affiliate.

First Name
Last Name
Address
City
State
Zip code
Country
Phone
Fax
Email

Do you wish to be added to the E-POLY Discussion List?   Yes     No




Below, please choose which type of membership that would apply to you:

Member - American Chemical Society	Nonmember - American Chemical Society
$30.00, ACS POLY Member $20.00, ACS POLY Student $10.00, Overseas Postage (not in the USA)	$50.00, POLY Affiliate $50.00, POLY Student Affiliate $10.00, Overseas Postage, (not in the USA)

Payment Information
How do you wish to pay?  Credit Card   Check    Please invoice

Credit Card Information
Card Type  Choose Credit Card VISA Mastercard AMEX Discover
Name as it appears on the Card
Credit Card Number
Expiration (month/year)

Did anyone refer you?  If so, how?


Special Comments
please list your special comments here

Submit Form For Processing  

this form is powered and secured by by Formail.asp, "Sorted Sites"

Please make checks payable to "ACS Division of Polymer Chemistry Inc." mail to attn:  Neta Byerly, Business Manager, 410 Davidson Hall MC 0279, VA Tech, Blacksburg, VA 24061 USA.