Application for Student Membership

 

The Electrochemical Society

65 South Main Street

Pennington, NJ 08534 USA

 


* Indicates Required Field


Applicant Information

* Prefix:

 

* First (Given) Name:                                  Middle Name/Initial:                           * Last (Family) Name:

                       

 

Date of Birth:

* Month:                          * Day:                           * Year:

                   

 

Gender:

 

University Affiliation:

 

Faculty member attesting to eligibilty of student:

Name: Email:

 


Contact Information

 

* Mailing Address: 

 

* Line 1: 

Line 2: 

Line 3: 

* City: 

* State: 

* Country: 

* Postal Code: 

* Daytime Phone: 

Daytime Fax: 

* Email Address: 

* Verify Email Address: 

 

 


Section Affiliation

 

A member can only be affiliated with one Section.  Most often the appropriate Section will be the one closest to you.

(NOTE: If you select a section, additional dues will be applied to your final fee total.
If you do not wish to pay Section Dues, please select the "NO SECTION" option below.
)


       

 

 


Division Selections

 

Please choose a Primary/Voting Division - Required $3

       

Please choose as many Secondary Division Interests as you want.

 

Battery

Corrosion

Dielectric Science and Technology

Electrodeposition

Electronics and Photonics

Energy Technology

Fullerenes, Nanotubes and Carbon Nanostructures

High Temperature Materials

Industrial Electrochemistry and Electrochemical Engineering

Luminescence and Display Materials

Organic and Biological Electrochemistry

Physical and Analytical Electrochemistry

Sensor

 

 


Education

* At least one institution is required

 

Institution (Please list current institution first)

Dates Attended

Major Subject

Degree Earned

 

 


Student Membership

 

* Membership Type - Membership $15 + Division $3

 


Payment Information:

 

* First (Given) Name:

* Middle Name/Initial:

* Last (Family) Name:

Name as it appears on the Credit Card:

* Credit Card:  * Credit Card Number (Digits Only): 
* Expiration Month:  * Expiration Year: 

 


Comments

 

 

 


 

* I signify that all of the above information is accurate and current.

 

***** Please only click on the "Submit" button once, otherwise your credit card may be charged multiple times. *****