North Atlantic Chapter - SETAC  

North Atlantic Chapter
of the
Society for Environmental Toxicology and Chemistry
 

Membership Form





 

NACSETAC MEMBERSHIP APPLICATION / RENEWAL
MAY 1, 2011 - APRIL 30, 2012

Use this form to join, to renew, and to update your info or add changes throughout the year. Your information will be sent electronically when you submit the form. Payment will be handled after this form is submitted.

Application Type New Member Renewal Info Update Only
Name: Title:
Affiliation
Address
City: State:   Zip/Postal Code
Telephone:
Home:
Work:
Fax:
Email:
Area of Expertise
Interested in being a speaker? Yes No
Speaking topics
Member of SETAC Yes No
Category of Employer Academic
 Government
 Business/Industry
Would you like to participate on chapter committees?  Yes No
Type of member Regular Member ($15 U.S. Funds)
 Student Member (free, but application required)  
 Silver Sustaining Member ($100)
 Gold Sustaining Member ($300)
 Platinum Sustaining Member ($500)
Payment Type Credit Card/Paypal Check No Payment Due

Current members: Please continue to support NAC by renewing your membership at this time.  All memberships expire in April.

Payment instructions, if any, will be given after this form is submitted.

Membership descriptions

 

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   Last changed on March 20, 2011

     Please direct any suggestions or comments to webmaster, Dodi Borsay Horowitz, at webmaster@nacsetac.org