2009 Membership
Application & Renewal
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Application Type
This application is for:
New Membership
Membership Renewal
Your Contact Info
Name:
John Q. Public
Affiliation:
State University
Mailing Address:
Department of Microbeam Analysis
1 Quantitative Road
City:
Anytown
State:
ST
Zip Code:
01234-5678
Country:
USA
E-mail:
jqpublic@microbeam.state.edu
Telephone:
+1 234 567 8901
Fax:
+1 987 654 3210
Membership in Affiliated Societies
I am a member of an MAS Affiliated Regional Society (AReS):
No
Yes:
I am a member of the Microscopy Society of America (MSA):
No
Yes
Member Dues & Services
My application is for membership type:
$35
‡
Regular
$0 Honorary*
$5
‡
Emeritus*
$5
‡
Student
* Honorary and Emeritus memberships are conferred
only
by vote of MAS Council.
‡
Dues paid by
January 1
receive "timely payment" discount of $5.
I would like to receive a subscription to
Microscopy and Microanalysis (M&M)
**:
No
$20 US mailing address
$45 Foreign mailing address
** MSA members already receive a subscription to M&M through their MSA dues.
Charitable Support
I wish to make a
tax deductable
contribution to the:
Chodos Fund
( supports student activities* )
No
$5
$10
$25
$50
$100
Fiori Fund
( supports technologist-oriented programming* )
No
$5
$10
$25
$50
$100
* Funds allocated at the discretion of MAS Council.
Payment Type
I will submit payment via:
PayPal (preferred): will accept Paypal login or credit card info
Personal check
Special Requests
Include my address on mailing labels that MAS makes available to
our Sustaining Members as a benefit and to other companies for a fee:
No
Yes
Member Feedback
I would like to bring the following comments to the attention of MAS Council:
n/a
