Please
complete this form and return via email to our secretary (jmcbee@u.washington.edu).
If you need to mail this form with your payment, our address is:
Pacific Northwest Mass Spectrometry
Group
P. O. Box 85191
Seattle, WA 98145-1191
Dues
for one year membership to PNWMSG (January 1 to December 31). Check one below.
___ Corporate
Sponsor - make check payable to "PNWMSG" $250
___ Individual
Member
Free
___ Student
Member (requires signature of research director) Free
Directory
information (provided electronically in a Windows Excel spreadsheet by request
only - e-mailed or faxed to requestor)
Name: ____________________________________________
e-mail
address:____________________________________________
Affiliation: ____________________________________________
FAX: ____________________________________________
Mailing
address:___________________________________________
____________________________________________
___
e-mail a directory to the above e-mail address OR
___
fax a directory to the above fax number
___
Check here if you do NOT want your address and contact information included in
the directory.
5/05