CCN Application Form

This form can be used for new applications. Current members can also use this form to update their web pages and/or contact information.

Please note that the Chemical Consultants Network has membership requirements and two classes of membership:

Class A - Membership With Web Page:  Dues $25 / year
Class A members are entitled to a web page and online directory listing on the CCN site describing their fields of expertise and services provided. They are typically individual chemists, biochemists or chemical engineers. Other chemistry-related applicants will be considered, subject to approval by the CCN Membership Committee.

Class B - Membership Without Web Page:  No Annual Fee
Class B members are entitled to the same benefits as Class A members, but will not receive a web page and online directory listing on the CCN web site. They typically have an interest or involvement with the chemical and allied sciences and industries.

Benefits of Membership
All members will receive notification of events and can benefit from attending and participating in CCN meetings and events. Class A members will receive a web page on the CCN site and will be listed on our Directory of Consultants page, so that information about their fields of expertise and the services they provide will be available to clients, and to other CCN members for networking purposes. Class A members are encouraged to include as much text as necessary on their web page to fully describe the services they provide to clients.

CCN is based in the Philadelphia, PA (USA) area, where our meetings and seminars are held. To gain full benefit from your membership you are encouraged to participate in our meetings in order to develop your networking and consulting skills.

Annual Dues Deadlines:
The dues year runs from Jan 1 to December 31st. Current members are required to pay dues for the new year by the 1st of March of that year in order to retain their web page on the CCN site. New members' dues paid during the year up and to November 1st of that year will be current for that year. New member dues paid after November 1st will also cover the entire following year.

When you complete this form you should print it and attach it to your check. The electronic copy you send will be used to create your web page. The printed copy will confirm your membership contact information for the Treasurer and remind you that without data, your site will be useless. Checks without an attached printed copy of your application form below will not be accepted.


Checks should be made Payable to Chemical Consultants Network.
Checks and forms should be sent to:

Michael R. Becker, Treasurer
Chemical Consultants Network
12 Stone Bridge Court
Langhorne, PA 19047-8004

Name
Company
Address

City State ZIP
Country
Email
Web Site http://
Telephone Day Evening Fax
Qualifications I am a member of the American Chemical Society
My membership number is in the box below:
I am a member of the American Institute of Chemical Engineers
My membership number is in the box below:
I would like the membership board of the CCN to evaluate my skills.
I can leave the box below blank:
Web Page on CCN I want a Web Page on the CCN Website.
I am submitting a New Member application.
This is an Update to my Current Web Page
I am a current member of Chemical Consultants Network
Dues CCN Membership with Web Page: Dues $25/year
(Leave checked for Update to Current Web Page)
CCN Membership without Web Page: Dues $0/year
How Did You
Find Out About CCN?
C&E News Ad
ACS Section Publication
Web search, i.e., Google, Yahoo, etc.
Referred by friend, peer
Other Organization
Other
Fields of Expertise Select up to Three Fields of Expertise from List





And/Or Enter Unlisted Fields Below:
Description of Services

You may include as much text as necessary to fully describe your services.


Print the page before you press this button. Select when have the printout in hand.
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Select to clear all fields and start over.

CCN does not send an Invoice

Please send your check and printed form to:

Michael R. Becker, Treasurer
Chemical Consultants Network
12 Stone Bridge Court
Langhorne, PA 19047-8004
Checks should be made Payable to:
Chemical Consultants Network

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