American Statistical Association
New York City
Metropolitan Area Chapter

Associate Chapter Membership
Application and Renewal Form


PRINT THIS PAGE AND COMPLETE THE FOLLOWING INFORMATION
	
     New Application: _____  Renewal: _____


     Name: _______________________________________________________________________


     Organization: _______________________________________________________________


     Mailing Address: ____________________________________________________________


     City, State, & Zip Code: ____________________________________________________


     Telephone Number (With Area Code): __________________________________________


     Email Address: ______________________________________________________________


     Membership Type: _____ Associate Member ($8.00) _____ Student Associate Member ($2.00)


     Comments: ___________________________________________________________________

     _____________________________________________________________________________

     _____________________________________________________________________________

Please make check or money order payable to:
American Statistical Association - New York City Metro Chapter

Mail the completed application and payment to:
Marcia Levenstein
Pfizer Inc.
235 East 42nd Street
Mail Stop: 219-07-01
New York, New York 10017-5755

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Page last modified on November 23, 2016

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