TANZANIA CHEMICAL SOCIETY

TCS

Govenment Chemist Laboratory Agency, Ocean Road /Luthuli Road, P.O Box 164, Dar es Salaam  Tel. No.: +255 22 2113383/4 Fax No.: +255 22 2113320 e-mail: gcla@gcla.go.tz

Form TCS 02

Tanzania Chemical Society Membership Application Form

Ordinary Membership

(Please fill in triplicate)

Last (or family) name: ................................. First name: ...............................

Other names: .............................................................. Sex: .....................

Nationality: ...........................................................................................

Present address: ......................................................................................

......................................................................................

Phone: .................... Fax: ........................... e-mail: .........................

Permanent address: ................................................................................

.................................................................................

University Educational Record:


 

Bachelor level

Masters level

Doctorate level
*Name of award:      
Awarding University:      
Year:      

(*tick as appropriate)

Any other important information about the applicant:

....................................................................................................................................................................................................................

Other University awards:

..........................................................................................................

Current employment and nature of duties/activities:

....................................................................................................................................................................................................................

I wish to apply for membership of the Tanzania Chemical Society and pledge to abide by its constitution.

I enclose a money order for TZS 20,000/= registration fee plus TZS 50,000/= annual subscription payable to theTanzania Chemical Society.

I understand that this amount is refundable in the event of unsucessful application.

I enclose postage stamps totalling Tanzanian shillings 2,500 as mailing costs for the membership certificate and the TCS constitution, should this application be successful.

Address:
P.O Box 164
Dar es Salaam
Phone: 
Tel. No.: +255 22 2113383/4 
Fax No.: +255 22 2113320
e-mail: gcla@gcla.go.tz
Bankers:
NBC (1997) Ltd.
Mlimani Branch
P.O. Box 35181
Dar es Salaam