HARRISBURG CHAPTER OF THE AMERICAN STATISTICAL ASSOCIATION

Member Application Form

Name: _____________________________________________________________

Organization: _______________________________________________________

Position: ___________________________________________________________

Business Address: ___________________________________________________

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Business Phone: _________________________________

Business Email: _________________________________

Are you a member of the American Statistical Association.
(Note that you do not have to be a member of ASA to join the Harrisburg Chapter)

YES       NO

The preferred method of sending newsletters is email. Where should we send you electronic newsletters?

BUSINESS       HOME

If you prefer not to receive an electronic newletter, where should we mail you newsletters?

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Home Address (if applicable): _________________________________________

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Home Phone: _________________________________

Home Email: _________________________________

Dues for annual membership in the Harrisburg Chapter of the ASA are are $10. Please make checks payable to “ASA-Harrisburg Chapter.”

Return Application to:

Lori Koontz
Treasurer, ASA-Harrisburg Chapter
30 Paddock Lane
Camp Hill, PA 17011