DVC-NOBCChE		Mark A. Jackson
P.O. BOX 250	or MAIL to:	Treasurer, DVC-NOBCChE
SPRING HOUSE, PA 19477		Rohm and Haas Company
		100 Independence Mall West
		Philadelphia, PA 19106-2399
		(215) 592-3592

Use this Form to pay Local and National Dues. Complete this page Then do :

1) "Edit/Select All/Copy" or Control C (Copy) to Clip Board

2) Next click on E-Mail and

3) "Paste" into the E-mail TEXT BOX

4) E-MAIL TO Mark A. Jackson at MAHYMJ@RohmHaas.Com

Please E-mail Mark A. Jackson (MAHYMJ@RohmHaas.Com)   with any questions.

DVC-NOBCChE Membership is open to any person who supports and is willing to work toward attaining the goals and objectives of the organization. Local dues are $10.00. There are two grades of National membership within the organization. A REGULAR membership ($75.00) has all the rights and privileges of membership outlined in the constitutional bylaws. An ASSOCIATE member ($50.00) may not vote or serve as a member of any policy-making body. University students may elect to be either ASSOCIATE members, or REGULAR members, or STUDENT MEMBERS at $10.00.

To be a member of the Delaware Valley Chapter, you must be a member of the National at any grade of membership

For National membership application and other information about the organization, contact:

NOBCChE National Office
P0. Box 77040
Washington, D.C. 20023

Located on the Howard University Campus 1-800-776-149

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DVC-NOBCChE APPLICATION FOR MEMBERSHIP (1999-2000)

Delaware Valley Chapter/Northeast Region

.______     New Member

_______    Renewal

______     Student

 

PERSONAL DATA: ( To insure accuracy, Please PRINT or TYPE)

 

Name: ______________________________________________________________________

 

Current Mailing Address:   ________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

 

Telephones: (work) ________________________________(Home)   ________________________

  (Please indicate the number at which you prefer to be  contacted)

(Fax): ________________________________

E-Mail Address: __________________________________________

 

EDUCATION:

Institution   __________________________________________

Dates of Attendance _______________________________________

Degree Awarded  _______________________________

 

PROFESSIONAL EXPERIENCE:

Company/Institution (Current)    ________________________________

Dates of Employment    ____________________________________________

Position    _________________________________________________

Company/Institution

(Previous)    ___________________________________________

Dates of Employment    _________________________________________

Position    __________________________________________________

 

MEMBERSHIP IN PROFESSIONAL AND HONOR SOCIETIES:

 

 

 

SCIENTIFIC RESEARCH AND INTERESTS:

Membership fees

1.     Full Membership with Voting privileges ($75.00)         ______________

2.     Associate Membership (NON-VOTING) ($50.00)         ______________

3.     Student Membership (NON-VOTING) ($10.00)             _____________

4.     Delaware Valley Chapter Local Dues ($10.00                   $10.00     

                                           TOTAL DUE:                               ______________

 

Please make check in the above amount (TOTAL DUE) payable to: DVC-NOBCChE. Please forward completed application and check (NO CASH - check must be   included) to:

  Mark A. Jackson
  Treasurer, DVC-NOBCChE
  Rohm and Haas Company
  100 Independence Mall West
  Philadelphia, PA 19106-2399

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