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AZ HPS
The Executive Council of the Arizona Chapter of the Health Physics
Society is soliciting applications for membership in the Chapter.
The Chapter is planning to be very active and needs additional members to
ensure that the efforts and activities are not limited to the relatively
limitied number of members residing in Arizona. Please feel free to apply
by e-mail or by postal delivery. Aplicants submitting electronic
applications will receive a dues notice by postal delivery. REMEMBER NOT
TO REPLY TO RADSAFE. Reply to sender, address below.
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Arizona Chapter of the Health Physics Society
c/o ASU RPF Box 873501 Tempe, AZ 85287-3501
Application for Membership
Date______________________
Name_________________________________________________________________
Residence____________________________________________________________
Business Address_____________________________________________________
_____________________________________________________________________
Phone Number: Business________________ Home________________
Email Address_________________________
Preferred Address for AZCHPS Mail: Business_________ Home_________
Membership in the National Health Physics Society:
_____None _____Plenary _____Associate _____Student Other:________
Nature of Present Work:________________________________________________
_______________________________________________________________________
Professional Interests:________________________________________________
_______________________________________________________________________
Sugestions for Topics and Functions:___________________________________
_______________________________________________________________________
Send Application Form and $5.00 dues to:
AZ HPS
c/o ASU RPF
Box 873501
Tempe, AZ 85287-3501
Make checks payable to: Arizona Chapter, Health Physics Society
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Bill Pitchford Bill.Pitchford@asu.edu
Radiation Protection Facility (602)965-6140 voice
Arizona State University http://www.asu.edu
Campus Box 873501 (602)965-6609 facsimile
Tempe, Arizona 85287-3501 http://physics.isu.edu