Pacmass Sponsor Membership Form

Please complete this form and mail with your payment to our address:

Pacific Northwest Mass Spectrometry Group

P. O. Box 85191

Seattle, WA 98145-1191

Dues for one year sponsor membership to PNWMSG (January 1 to December 31).

___ Corporate Sponsor - make check payable to "PNWMSG" $250

Directory information (provided electronically in a Windows Excel spreadsheet by request only - e-mailed or faxed to requestor)

Name: ____________________________________________

e-mail address:____________________________________________

Affiliation: ____________________________________________

Telephone: ____________________________________________

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.

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