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
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Form TCS 04
Last (or family) name: ................................. First name: ...............................
Other names: .............................................................. Sex: .....................
Nationality: ...........................................................................................
Present address: ......................................................................................
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Phone: .................... Fax: ........................... e-mail: .........................
Permanent address: ................................................................................
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| Awarding University: | |||
| Expected year of award: |
(* tick as appropriate)
Any other important information about the applicant:
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Other University awards:
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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 10,000 registration fee plus TZS 20,000 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 TZS 2,500 as mailing costs for the membership certificate and the TCS constitution, should this application be successful.
Signature of applicant ......................................................................
Date: ............................................................................................
| 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 |