Western Tennessee Chapter, American Statistical Association
Membership Application Form

Western Tennessee Chapter dues are $5 per year for full and associate members, and $2 per year for student members. 

Name ( last, first, middle initial): ______________________________________ 

Organization: _____________________________________________________ 

Mailing address: ___________________________________________________ 

                        ___________________________________________________ 

                        ____________________________________________________ 

                        ____________________________________________________ 

                        ____________________________________________________ 
 

Phone: _____________________________________________________ 

Fax: _____________________________________________________ 

E-mail: _____________________________________________________ 
 

May we post your name and E-mail on our Homepage under members?  YES   NO 
 

Please mail completed form with payment to: 

Xiaowei Yan, Treasurer
Western Tennessee Chapter of the ASA
University of Memphis
Dunn Hall, Mailbox 334
Memphis, TN  38152-3240 
Email: xyan@memphis.edu

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