AATCC Individual Membership Application

All fields on this page must be completed.

Application for:  New Membership  Reinstatement  Transfer to another classification

How did you hear about AATCC?  Colleague/Friend  Newsletter  Website  Tradeshow
 Conference/Workshop  Other (specify):

CONTACT INFORMATION
 Dr.  Miss  Mr. First (Personal) Name Middle Last (Family) Name
 Mrs.  Ms.
Company/School/Organization Division/Department Job Title

Primary Address:  Organization  Home

Number & Street/PO Box

City State/Province Postal Code Country

Email Phone Mobile/Cell Fax

Alternate Address:  Organization  Home

Number & Street/PO Box

City State/Province Postal Code Country

Email Phone

MEMBER CLASSIFICATION
1 year 2 years 3 years 1 year (DN) *
Senior*  US$120  US$215  US$305  US$60

 US$35  US$10
College/University Expected Grad. Date
Student
Major Expected Degree

*Developing Nations members receive the online journal, but no print copy. See www.aatcc.org for a list of eligible countries.

PAYMENT (The Submit button will transmit credit card information by email. Security is not guaranteed.)
Payment in US funds must accompany application. Checks and wire transfers must be drawn on a US bank.
 MasterCard  Visa
 American Express Card Number Expiration Security Code
 Check  Wire (+ $30)
Month Year
Cardholder’s Name Signature Expiration

1 Davis Drive | PO Box 12215 | Research Triangle Park, NC 27709-2215 | USA

Headquarters: +1.919.549.8141 | Fax: +1.919.549.8933 | www.aatcc.org
AATCC Individual Member Profile

INDIVIDUAL MEMBER
First (Personal) Name Middle Last (Family) Name

INTEREST GROUPS
Participate in any or all interest groups. Vote in one interest group of your choice.
Learn more at www.aatcc.org/mem/indiv/interestgroups. (Senior members only)

 Chemical Applications  Chemical Applications

 Concept 2 Consumer®  Concept 2 Consumer®
 Materials  Materials

EDUCATION
Degree (BA, MS, PhD) Major College/University Year Graduated

EXPERIENCE
Employer Job Title From (year): To (year):

DEMOGRAPHIC INFORMATION
The following is collected for demographic purposes only. Individual confidentiality will be maintained although statistical data may be
published in the aggregate.
Gender: Date of Birth:
 Female
 Male Month Day Year

Month Day Year

1 Davis Drive | PO Box 12215 | Research Triangle Park, NC 27709-2215 | USA

Headquarters: +1.919.549.8141 | Fax: +1.919.549.8933 | www.aatcc.org