Please fill out this form to submit your application for membership in College Chemistry Canada.

Membership Dues are $20 for 1 year (May 1- April 30).
Applications received after March 1 will be applied to the following membership year (beginning May 1).


Conference registration includes your membership dues. If you are planning to attend this year's conference, you don't need to submit this application.


First Name: Institution:
Last Name: Mailing Address:
Phone: Address 2:
  EXT: City:
Email Address: Province: Postal code:


Please enter any comments, questions, or other details in the text box.

You can pay by cheque or through Paypal
(the Paypal option includes an extra $0.75 service charge ).
Select the appropriate option below.

Select a payment method:


Sorry, the Paypal option is temporarily unavailable.

This option will allow you to use a credit card through your existing Paypal account. An extra $0.75 service charge is added.
Note, no personal information is passed to Paypal,
only the Membership ID and amount due is sent.
You may have to open a Paypal account if you do not already have one
(which can be done as you pay).

Cheque This option will allow you to mail a cheque.
Details for mailing your cheque are provided after submitting your application.


Please complete all fields.

You may be contacted directly for further details if necessary.

If you make a mistake or need to change something after the fact, please don't resubmit this page, please contact the .