Membership Application Form
The Scientech Club

Please provide the following information:    

Last Name:      First Name:      Spouse's Name:  

Salutation:    Mr.    Dr.    Ms.    Mrs.    Miss    Other: 

        Desired Nickname (if any):

Club Sponsors (Note A):   1.    2.

Residence Address:      City:  

        State:      Zip Code:      County:  

Phone:      Email Address:  

Desired Newsletter Distribution (Note B):   E-Mail (PDF)    E-Mail (DOC)

Date of Birth:      Place:  

Military Service:  

Education:

      High School:    Year:  
      College:    Degree:   Year:  
      Graduate School:    Degree:   Year:  
      Add'l Schooling:    Degree:   Year:  

Societies:  

Interests & Hobbies:  

Honors:  

Last Business:      Active    Retired

Positions Held:   

Note A: Each applicant must be sponsored by two current Club members. If you do not have a sponsor, please contact the Membership Chairman.

Note B: Weekly newsletters are normally distributed to all members by e-mail. (Printed copies will be available at each luncheon meeting for members unable to receive e-mail.) Please indicate your preferred file format for e-mail, either Adobe Portable Document Format (PDF), or Microsoft Word (DOC). The free Adobe Reader can be downloaded from here

Note C: Upon acceptance of this application the new member agrees to attend an orientation session to learn about club history, organization and activities including judging at science fairs as well as other volunteer opportunities. At the orientation, the D.J. Angus-Scientech Educational Foundation and its relationship to The Scientech Club will be explained.

   I accept the provisions of Note C above.    I DO NOT accept the provisions of Note C above