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Page 1: Application for New ASA Student Chapter · Name of New ASA Student Chapter: (for example, MyState University ASA Student Chapter) State: Zip: School Information Institution Name:

Name of New ASA Student Chapter: (for example, MyState University ASA Student Chapter) 

State: Zip: 

School  Information 

Institution Name: 

City/State/Country: 

Faculty Advisor Information 

Name: 

 Title: 

Email: 

Phone: 

Student  Chapter  President  Information  Name: 

Level (Grad, UG, or High School): 

Email:  

Mailing address: 

City:

Make sure to attach this PDF to your email. 

Promoting the Practice and Profession of Statistics®

Application for New ASA Student Chapter Submit  to  [email protected]

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