Membership Application Form

Calendar Year: January 1 – December 31,

Salutation: / - click to select -Dr.Mr.Ms. / Work affiliation:
Name: / Work address:
Home address:
Mail stop:
City/State/ZIP: / City/State/ZIP:
Home phone: / Work phone:
Home fax: / Work fax:
Home e-mail: / Work e-mail:
Prefer mail sent to: / Home / Work / (home is encouraged because of potential mail rooms problems)

It is not necessary to be a member of ANS National to be a member of ANS Trinity. However, only ANS National members may serve in the offices of Section Chair or Section Vice-Chair. Dues are free to Emeritus Section Members, 60 or over, having at least 10 years membership, and retired. Dues are also free to Students. Please check one of the following (X):

Member ($15) / Emeritus Member ($0) / Student Member ($0)

Payment: Please pay your dues through our web site (from the “Join” page at the URL above) or submit your check, payable to “ANS Trinity,” with this form to the address above.

The following information for our member database helps to plan activities around a profile of our Section members:

Major areas of professional interest or expertise:
I am currently an ANS National member / Yes / No / If so, member number:

What ANS Professional Divisions (if applicable)?

Accelerator Applications / Fusion Energy / Nuclear Installations Safety / Nuclear Nonproliferation (TG)
Aerospace Nuclear Science & Technology / Human Factors, Instrumentation & Controls / Operations & Power / Young Members Group (TG)
Biology & Medicine / Isotopes & Radiation / Radiation Protection & Shielding / Computational Medical Physics (WG)
Decommissioning & Environmental Sciences / Materials Science & Technology / Reactor Physics / Nuclear Production of Hydrogen (WG)
Education, Training & Workforce Development / Mathematics & Computation / Robotics & Remote Systems
Fuel Cycle & Waste Management / Nuclear Criticality Safety / Thermal Hydraulics
I am currently a member of ANS National Committee(s)
Which one(s)?

Trinity Section activities:

I am interested in being an Officer or member of the Executive Committee
I am willing to serve on a Section Committee:
Public information and outreach
Communications
Emeritus
Membership
“One-shot” assignments such as auditing, election inspection, nominating committee, etc.
I have the following burning interest I would like to pursue with the Section:
New members: Was there an ANS Trinity member who influenced you to join?
Any additional comments or questions:

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