APPLICATION FORM

Application form for the membership in the I. Society for Theoretical Chemical Physics U.S.

Name: ________________________________________________

Affiliation: ________________________________________________

Address: ________________________________________________

City/State/ZIP: ________________________________________________

Tel :

Fax:

E-mail:

Web:

Membership fee: ___ $25 member ______$ 5 student member

Signature ____________________________

Date ______________________________

Mail (with the check) to: Dr. K. Rupnik

ISTCP-US

Department of Chemistry

Louisiana State University

Baton Rouge, LA 70803

e-mail: chrupn@lsuvax.sncc.lsu.edu

url: http://dorpnk.chem.lsu.edu/ictcp.html

Created by Kresimir Rupnik 1-20-96