ASA Chapter Visitation Request Form

ASA Chapter Visitation Request Form

Please provide the following information to facilitate scheduling of visitors to your chapter through the ASA office, preferably to coincide with a Chapter meeting. During the visit, there should be a meeting with the Chapter officers.
Chapter*
Briefly describe your chapter membership (e.g. 50-50 academic/industry, majority government, biomedical-pharmaceutical-academic mix, etc):*
Please provide a general or specific date for the visitation. If your chapter has routinely scheduled meetings, provide this information. If a specific date is selected, provide two possible choices if you can. A general date, for example, could be 'September through November 2011, monthly meetings, noon until 2:00 p.m., 3rd Tuesday." A specific date, for example, could be "May 15, 2011, evening meeting 5-7 p.m., Boston."
Date of visitation*
Purpose of the visitation is to:

Attract prospective new membersRevitalize and stimulate current membersImprove communication with ASAOther
Type of lecture most appropriate for your chapter:

ASA initiatives“Big Picture” overview of ASA activitiesScience policyStatistical applicationsviewpointWays ASA supports chaptersOther
Note: Details of lecture content can be worked out between visitor and chapter contact once visitor is selected and initial contact is made.
Contact*

First NameLast Name
Contact's phone number*

Area CodePhone Number
Contact's email*
Submitter (if different from above)

First NameLast Name
Submitter's phone number

Area CodePhone Number
Submitter's email
Should be Empty: