Membership Application Form
Personal Information
Last Name
First Name
Citizenship
Institution
Current Information
Address
Phone Number
Fax Number
Email
URL
Permanent Information
Address
Phone Number
Fax Number
Email
URL
Academic Information
Please list all Degree(s) Obtained or Being Pursued
Degree
Major
Institution
Date
Bachelors
Masters
Ph.D.
Other
Would you allow TSCA to publish the above information in its publications such as the TSCA Members' Guide?
Yes
No
Would you like to Join a TSCA-Affilate in one of the following scientific areas?
Other (see below)
Chemistry & Chemical Engineering
Civil and Environmental Engineering
Education
Electrical Engineering
Industrial Engineering
Information Technology
Life Sciences
Management
Mathemactics
Mechanical Engineering
Physics
If the desired area is not listed, please suggest one:
I would like to Join TSCA as:
TS:
TEMPORARY associate Status
(for members in Tunisia only)
Fee =
$0.00
SM:
Student Member
(Tunisian students with minimum Tunisia "Bac" or Equivalent)
Fee =
$25.00
PM:
Professional Member
(Tunisian Professionals with minimum Tunisia "Bac" or Equivalent)
Fee =
$50.00
AM:
Associate Member
(Tunisian not meeting the requirement of student or professional membership, and non-Tunisians)
Fee =
$50.00
CM:
Corporate Member
(Tunisian research institutions, scientific organizations, or corporations with R&D orientation)
Fee =
$125.00
ACM:
Associate Corporate Member
(Non-Tunisian research institutions, scientific organizations, or corporations with R&D orientation)
Fee =
$125.00
Corresponding the Membership Category:
Your membership dues are:
Donation (if any):
Please mail the approprite fees to:
by Regular Mail
or via Wire Transfer
The Tunisian Scientific Consortium
PO Box 13238
Minneapolis, MN 55414
USA
The Tunisian Scientific Consortium
First Bank, Dinkytown Office
1315 Fourth Street Southeast
Minneapolis, MN 55414, USA
Routing Number: 091000022
Account Number: 116540125956
