OCLBASA Membership Form

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This is the Membership form for the Orange County Long Beach Chapter of the American Statistical Association (OCLBASA)

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E-post *

Please indicate your reason for submitting this form *

To initiate my Chapter membership

To renew my Chapter membership

To update my Chapter Directory record

Please provide the date you are filling up this form. *

ÅÅÅÅ

What is your First Name? *

What is your Last Name? *

Please provide the name of your primary Business/Academic Institution affiliation. *

Please indicate your membership type (select one only) *

Dues should be paid by a check made payable to "OCLBASA". Please send your payment together with this form to OCLBASA c/o Kitty Guo, Chapter Treasurer, at this address: 1 League #61390, Irvine CA 92602

Student (currently enrolled in a university/college degree program) ........... $5

Regular/Professional ................................. $10

Other (e.g., retired) ................................... $10

What is your preferred mailing address? (Please provide the complete mailing address.)

What is your preferred telephone number (including the area code)?

Are you a current member of the American Statistical Association (ASA)? *

Yes

No (If you are not currently a national member of the ASA and would like to join, please visit http://www.amstat.org/membership/index.cfm

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