The Southern California Chapter of the American Statistical Association
Membership Form

  Name (please print)

  Business/Academic Affiliation

  Preferred Mailing Address

  If your affiliation is academic: What is your department(or unit)?

If your affiliation is academic: Please indicate your status

  Faculty_________      Student__________      Other___________

Preferred telephone number (including the area code)

  E-Mail Address

  FAX Number

  Please indicate your reason for submitting this form

  To initiate my Chapter membership _____    To renew my Chapter membership _____   To update my Chapter Directory record _____

  If you are sending this form to initiate your Chapter membership, please read the Chapter's statement of purpose and sign the agreement

  The Southern California Chapter of the American Statistical Association exists for the purpose of promoting unity
  within the community of statisticians, especially within the Southern California area, and of contributing to
  statistical education within the professional community and the general public.  By its efforts, the Chapter hopes to
  increase the contribution of statistics to human welfare everywhere.

  In becoming a member of this Chapter, I agree to support its purposes and objectives.

       Signed ____________________________________________________          Date _______________________________

  Are you a current member of the American Statistical Association?    Yes _____   No _____

  If NO, would you like to receive information concerning National membership in the ASA?    Yes _____   No ______

  Chapter dues:  Indicate your Chapter dues category (dues amount shown in parentheses)

  Regular   ($12.00) ______          Student   ($6.00) _____          Retired ($6.00) _____

  Dues should be paid by a check made to SCASA.  Please send your dues payment together with this form to Jay Bartroff, Chapter
  Treasurer, at the address shown below.

Jay Bartroff USC Math Dept. 3620 S. Vermont Ave. KAP 104 Los Angeles, CA 90089-3620

Phone: (213) 740-1044 Fax: (213) 740-2424 bartroff@usc.edu

  Gifts to the Southern California Chapter of the American Statistical Association are deductible as charitable
  contributions for U.S. Federal Income Tax purposes.  Payment of membership dues and subscriptions are not tax
  deductible as charitable contributions, but may be deductible under Section 162 of the Internal Revenue Code

asordinary and necessary business expenses.