Please print out this form, fill it, and return it along with your Annual Membership fee of US $ 15 (students $10) for the calendar year 2000 or of US $ 150.00 for Life Membership. We strongly encourage our members to become Life Members. The payment should be made in the form of a personal check payable to "American Chapter of the IPA" and mailed to Dr. Savitri Iyer, Department of Physics and Astronomy, SUNY at Geneseo, 1 College Circle, Geneseo, NY 14454. If you wish to support our program of journal donations to Indian institutions, an additional voluntary contribution (suggested amount: $ 10.00) is requested. Canadian members are requested to send the subscription in the form of a money order, bank draft, or personal check involving US funds.

1. Name:

2. Position

Address:

3. Telephone: (office)~~~~~~~~~~~~~~~~~~~~~~(home)

4. FAX number:

5. E-mail address:

6. Research Interests (please pick no more than 2):

( ) Astrophysics ( ) Atomic, Molecular & Optical Physics

( ) Biological Physics ( ) Chemical Physics

( ) Condensed Matter ( ) Fluid Dynamics

( ) High Polymer Physics ( ) Materials Physics

( ) Nuclear Physics ( ) Physics of Beams

( ) Particles & Fields ( ) Plasma Physics

( ) Experimental ( ) Theoretical

7. Year Ph.D Received/Expected:

Institution:

8. Brief Description of Scientific Activities (75 words or less)