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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