1. Healthcare

2015 Membership Application
PO Box 4429
Danbury, CT 06813-4429 USA
Phone: Toll-free: 800.242.4363 (U.S.) or
visit www.aiche.org/phone (outside
U.S.) to obtain your country’s number.
Fax: 203.775.5177
Please return completed form to address/email at right.
Web: www.aiche.org • Email: [email protected]
2 Select Forums/Divisions
Membership Information
o Chemical Engineering & the Law Forum . . . . . . . . . . . . . . $20
o Computational Molecular Sci & Eng Forum. . . . . . . . . . . . . $10
o Nanoscale Science & Engineering Forum. . . . . . . . . . . . . . $10
o North American Mixing Forum. . . . . . . . . . . . . . . . . . . FREE
o Particle Technology Forum. . . . . . . . . . . . . . . . . . . . $15
o Pharmaceutical Discovery, Development & Manufacturing Forum. . . FREE
o Sustainable Engineering Forum. . . . . . . . . . . . . . . . . . $20
o Upstream Engineering & Flow Assurance Forum. . . . . . . . . . . $36
o Catalysis & Reaction Engineering Division. . . . . . . . . . . . . . $20
o Computing & Systems Technology Division . . . . . . . . . . . . . $10
o Education Division. . . . . . . . . . . . . . . . . . . . . . . . $7
o Food, Pharmaceutical & Bioengineering Division. . . . . . . . . . $10
o Forest Bioproducts Division . . . . . . . . . . . . . . . . . . . . $9
o Fuels & Petrochemicals Division. . . . . . . . . . . . . . . . . . $10
o Management Division. . . . . . . . . . . . . . . . . . . . . . $10
o Materials Engineeering & Sciences Division. . . . . . . . . . . . $10
o Nuclear Engineering Division. . . . . . . . . . . . . . . . . . . $10
o Process Development Division . . . . . . . . . . . . . . . . . . $10
o Separations Division. . . . . . . . . . . . . . . . . . . . . . . $15
o Transport & Energy Processes Division. . . . . . . . . . . . . . . $7
COMPANY/UNIVERSITY (If Applicable)
LAST NAME/SURNAME/FAMILY NAME
FIRST NAME/GIVEN NAME
JOB TITLE
Mailing Address:
Home
Business
ADDRESS LINE 1/BUILDING NAME/FLOOR
ADDRESS LINE 2/STREET ADDRESS
CITY
STATE/PROVINCE
POSTAL CODE
Divisions with Publications included:
COUNTRY
Gender
Female
PrintWebBoth
North America
o Environmental, Env. Progress & Sustainable Energy o $45 o $45 o $75
o Safety & Health, Process Safety Progress
o $45 o $45 o $75
Male For demographic purposes only.
Please Provide the Following Contact Information:
(Required to process application. Used for Institute business only.)
PrintWebBoth
Outside North America
o Environmental, Env. Progress & Sustainable Energy o $95 o $45 o $125
o $95 o $45 o $125
o Safety & Health, Process Safety Progress
HOME PHONE
3 Select Technical Societies
BUSINESS PHONE
Mem
PRIMARY E-MAIL ADDRESS
SECONDARY E-MAIL ADDRESS
/
DEGREE (1) /
(M/D/Y)
/
DEGREE (2) /
/
/
(M/D/Y)
North America
Print Web
Chemical Engineering Progress (CEP)*
AIChE Journal
o $175 o $228
Biotechnology Progress
o NA o $74
Food & Bioproducts Processing
o NA o $69
UNIVERSITY
/
MONTH
/
DAY YEAR
U.S. Tax Deductibility: AIChE dues, including CEP subscription of $31, are tax deductible to the extent
allowed by law. Please consult your tax advisor for further information.
1 Select Your Membership Category
What year did you receive your BS?
o Before 2012 o 2012 o 2013
o 2014
o 2015
o I am currently unemployed
o I reside outside the U.S.
o If applying for full time Graduate Student
rate, please supply:
Graduation Date:
2014 Institute Dues Chart (U.S.)
Yr. of B.S. Degree
Dues/yr.
Before 2012
$199
2012$150
2013$100
2014, 2015
$50
Graduate Student
$50
Unemployed$50
Name of School:
Local Section* Name
*View www.aiche.org/community/local-sections/find
$
Outside North America
Chemical Engineering Progress (CEP)*
AIChE Journal
Biotechnology Progress
Food & Bioproducts Processing
o $30†
o $295
o NA
o NA
Both
Included
o $281
——
o $152
o Included ——
o $215 o $395
o $74
——
o $69
o $152
*CEP magazine is available online to all members. The paper magazine is sent to all
members with the exception of World Bank Level 1 members ($49 dues) who must pay $31
for the paper magazine.
5 Total Your Payment
Institute Dues
Division/Forum Dues
Technical Society Dues
Publication Subscription(s)
Local Section Dues
Total Promo Code ———————
$ __________
$ __________
$ __________
$ __________
$ __________
$ __________
Form of Payment: o Check enclosed (payable to AIChE)
Credit Card: o AmEx o MasterCard o Visa o Discover o Diners Club
CARD#
© 2015 AIChE 1042_15 • 01.15
o $300
o $75
o $50
o $50
o $50
o $75
4 Select Publications
UNIVERSITY
MAJOR(S)
DATE OF BIRTH
Non-mem
Center for Innovation and Entrepreneuring Excellence (CIEE) o $20 Design Institute for Emergency Relief Systems (DIERS)
o $25 Institute for Sustainability (IfS)
o $25 International Metabolic Engineering Society (IMES)
o $25 International Society for Water Solutions (ISWS)
o $15 Society for Biological Engineering (SBE)
o $15 CARDHOLDER’S NAME
EXPIRATION DATE
CARDHOLDER’S SIGNATURE
RATE CHART
Country Dues Country Dues Country Dues
Country Dues
Afghanistan 49
Albania 79
Algeria 79
American Samoa 149
Andorra 199
Angola 79
Anguilla 199
Antarctica 199
Antigua Barbuda 199
Argentina 149
Armenia 79
Aruba 199
Australia 199
Austria 199
Azerbaijan 79
Bahamas 199
Bahrain 199
Bangladesh 49
Barbados 149
Belarus 199
Belgium 199
Belize 149
Benin 49
Bermuda 199
Bhutan 49
Bolivia 79
Bosnia & Herzegovina 199
Botswana 149
Bouvet Island 199
Brazil 79
British Indian Ocean Terr 199
Brunei Darussalam 199
Bulgaria 79
Burkina Faso 49
Burundi 49
Cambodia 49
Cameroon 79
Canada 199
Cape Verde 79
Cayman Islands 199
Central African Republic 199
Chad 49
Chile 149
China 79
Christmas Island 199
Cocos (Keeling) Islands 199
Colombia 79
Comoros 49
Congo 199
Congo-Democratic Republic 199
Cooks Island 199
Costa Rica 149
Cote Dlvoire 199
Croatia (Hrvatska)
199
Cuba 79
Cyprus 199
Czech Republic 149
Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt
El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France France - Metropolitan French Guiana French Polynesia
French Southern Terr Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard McDonald Islands Holy See (Vatican City) Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Lao People Demo Republic Latvia All Rates in US Dollars • All rates valid through December 31, 2015
199
79
149
79
49
79
79
79
199
49
149
49
199
199
79
199
199
199
199
199
199
149
199
79
199
49
199
199
199
199
199
79
49
49
79
49
199
199
79
199
149
199
49
79
79
199
199
199
79
199
79
199
49
199
199
199
149
Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia (Yugoslav Rep) Madagascar Malawi Malaysia Maldives Mali Marshall Islands Mauritania Mauritius Mayotte Mexico Micronesia-Fede Moldova - Republic Of Monaco Mongolia Montserrat
Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau
Palestine Papua New Guinea
Paraguay
Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda 79
199
199
199
199
149
199
199
199
49
49
149
199
49
79
49
149
199
149
199
199
199
49
199
79
49
199
79
199
49
199
199
199
199
79
49
49
199
199
199
199
149
49
149
49
49
79
79
79
149
199
199
199
199
149
199
49
Saint Kitts And Nevis 199
Saint Lucia 199
Samoa 199
San Marino 199
Sao Tome And Principe 199
Saudi Arabia 199
Senegal 49
Serbia/Kosovo 79
Seychelles 149
Sierra Leone 49
Singapore 199
Slovakia (Slovak Republic) 149
Slovenia 199
Solomon Islands 199
Somalia 49
South Africa 149
South Georgia 199
South Korea
199
Spain 199
Sri Lanka 79
St. Vincent Grenadines 149
St. Helena 199
St. Peirre And Miquelon 199
Sudan 199
Suriname79
Svalbard Jan Mayen Isl 199
Swaziland 79
Sweden
199
Switzerland 199
Syrian Arab Republic 199
Taiwan 199
Tajikistan 199
Tanzania - United Republic 199
Thailand
79
Togo 49
Trinidad And Tobago 149
Tunisia 79
Turkey149
Turkmenistan
79
Uganda 49
Ukraine 79
United Arab Emirates 199
United Kingdom 199
United States 199
Uruguay 149
Uzbekistan 49
Vanuatu 199
Venezuela 149
Vietnam 199
Virgin Islands (British) 199
Virgin Islands (U.S.) 199
Wallis And Futuna Islands 199
Western Sahara 199
Yemen 49
Yugoslavia 199
Zambia 49
Zimbabwe 199