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address_line_1 ginput_address_line_1 gform-grid-col" id="input_9_4_1_container"> <input type="text" name="input_4.1" id="input_9_4_1" value="" aria-required="true"/> <label for="input_9_4_1" id="input_9_4_1_label" class="gform-field-label gform-field-label--type-sub ">Address Line 1</label> </span><span class="ginput_full address_line_2 ginput_address_line_2 gform-grid-col" id="input_9_4_2_container"> <input type="text" name="input_4.2" id="input_9_4_2" value="" aria-required="false"/> <label for="input_9_4_2" id="input_9_4_2_label" class="gform-field-label gform-field-label--type-sub ">Address Line 2</label> </span><span class="ginput_left address_city ginput_address_city gform-grid-col" id="input_9_4_3_container"> <input type="text" name="input_4.3" id="input_9_4_3" value="" aria-required="true"/> <label for="input_9_4_3" id="input_9_4_3_label" class="gform-field-label gform-field-label--type-sub ">City</label> </span><span class="ginput_right address_state ginput_address_state gform-grid-col" id="input_9_4_4_container"> <input type="text" name="input_4.4" id="input_9_4_4" value="" aria-required="true"/> <label for="input_9_4_4" id="input_9_4_4_label" class="gform-field-label gform-field-label--type-sub ">State / Province / Region</label> </span><span class="ginput_left address_zip ginput_address_zip gform-grid-col" id="input_9_4_5_container"> <input type="text" name="input_4.5" id="input_9_4_5" value="" aria-required="true"/> <label for="input_9_4_5" id="input_9_4_5_label" class="gform-field-label gform-field-label--type-sub ">ZIP / Postal Code</label> </span><span class="ginput_right address_country ginput_address_country gform-grid-col" id="input_9_4_6_container"> <select name="input_4.6" id="input_9_4_6" aria-required="true"><option value="" selected="selected"></option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antarctica">Antarctica</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="Bahamas">Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Bouvet Island">Bouvet Island</option><option value="Brazil">Brazil</option><option value="British Indian Ocean Territory">British Indian Ocean Territory</option><option value="Brunei Darussalam">Brunei Darussalam</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cabo Verde">Cabo Verde</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="China">China</option><option value="Christmas Island">Christmas Island</option><option value="Cocos Islands">Cocos Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Congo, Democratic Republic of the">Congo, Democratic Republic of the</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Curaçao">Curaçao</option><option value="Cyprus">Cyprus</option><option value="Czechia">Czechia</option><option value="Côte d'Ivoire">Côte d'Ivoire</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands">Falkland Islands</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Guiana">French Guiana</option><option value="French Polynesia">French Polynesia</option><option value="French Southern Territories">French Southern Territories</option><option value="Gabon">Gabon</option><option value="Gambia">Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option><option value="Holy See">Holy See</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Isle of Man">Isle of Man</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option><option value="Korea, Republic of">Korea, Republic of</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macao">Macao</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="North Macedonia">North Macedonia</option><option value="Northern Mariana Islands">Northern Mariana Islands</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Palestine, State of">Palestine, State of</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Pitcairn">Pitcairn</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russian Federation">Russian Federation</option><option value="Rwanda">Rwanda</option><option value="Réunion">Réunion</option><option value="Saint Barthélemy">Saint Barthélemy</option><option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Sint Maarten">Sint Maarten</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="South Africa">South Africa</option><option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option><option value="South Sudan">South Sudan</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria Arab Republic">Syria Arab Republic</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania, the United Republic of">Tanzania, the United Republic of</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tunisia">Tunisia</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Türkiye">Türkiye</option><option value="US Minor Outlying Islands">US Minor Outlying Islands</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="United States">United States</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Venezuela">Venezuela</option><option value="Viet Nam">Viet Nam</option><option value="Virgin Islands, British">Virgin Islands, British</option><option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="Åland Islands">Åland Islands</option></select> <label for="input_9_4_6" id="input_9_4_6_label" class="gform-field-label gform-field-label--type-sub ">Country</label> </span> <div class="gf_clear gf_clear_complex"></div> </div></li><li id="field_9_6" class="gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible" data-js-reload="field_9_6"><label class="gfield_label gform-field-label" for="input_9_6">Membership Type<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class="gfield_description" id="gfield_description_9_6">This should be the same as your ACS membership type. Affiliate Membership is for non-ACS members who wish to be just ORGN members.</div><div class="ginput_container ginput_container_select"><select name="input_6" id="input_9_6" class="medium gfield_select" aria-describedby="gfield_description_9_6" aria-required="true" aria-invalid="false"><option value="Regular ($15/year)">Regular ($15/year)</option><option value="Student ($5/year)">Student ($5/year)</option><option value="Affiliate Member ($15/year)">Affiliate Member ($15/year)</option></select></div></li><li id="field_9_7" class="gfield gfield--type-radio gfield--type-choice gfield_contains_required field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible" data-js-reload="field_9_7"><label class="gfield_label gform-field-label">Dues Payment Authorization<span class="gfield_required"><span class="gfield_required gfield_required_asterisk">*</span></span></label><div class="gfield_description" id="gfield_description_9_7">For faster access to the ORGN website, call ACS Membership Services at 800-333-9511 or 614-447-3776 – You will be given Organic Division member status instantly and can pay for your membership while on the phone. This can only be completed during normal business hours. Please be aware that your membership will not be active until the next day.</div><div class="ginput_container ginput_container_radio"><ul class="gfield_radio" id="input_9_7"> <li class="gchoice gchoice_9_7_0"> <input name="input_7" type="radio" value="By checking this box I authorize the ACS to bill me for the appropriate membership dues to join the ACS-Division of Organic Chemistry(ORGN, 521) - Take 3-5 business days" id="choice_9_7_0"/> <label for="choice_9_7_0" id="label_9_7_0" class="gform-field-label gform-field-label--type-inline">By checking this box I authorize the ACS to bill me for the appropriate membership dues to join the ACS-Division of Organic Chemistry(ORGN, 521) - Take 3-5 business days</label> </li> <li class="gchoice gchoice_9_7_1"> <input name="input_7" type="radio" value="I will pay the membership dues now by contacting the ACS by phone. - Access the site tomorrow morning!" id="choice_9_7_1"/> <label for="choice_9_7_1" id="label_9_7_1" class="gform-field-label gform-field-label--type-inline">I will pay the membership dues now by contacting the ACS by phone. - Access the site tomorrow morning!</label> </li> <li class="gchoice gchoice_9_7_2"> <input name="input_7" type="radio" value="I have an award code for free membership" id="choice_9_7_2"/> <label for="choice_9_7_2" id="label_9_7_2" class="gform-field-label gform-field-label--type-inline">I have an award code for free membership</label> </li></ul></div></li><li id="field_9_8" class="gfield gfield--type-text field_sublabel_below gfield--has-description field_description_above gfield_visibility_visible" data-js-reload="field_9_8"><label class="gfield_label gform-field-label" for="input_9_8">Award Code</label><div class="gfield_description" id="gfield_description_9_8">Please note that DOC Undergraduate Awardees (UGA) do not need a code to receive a free membership. 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