2022 ADSA Individual Member Payment Form

2022 Academic Data Science Alliance ~Individual Member Payment Form~

Membership in ADSA is open to anyone who wants to support academic data science and the mission, vision, values of ADSA. ADSA activities are generally open to members and non-members alike, but individual and institutional members do have special benefits and opportunities. Note: membership dues, less the $100 benefits value, may be tax-deductible. Please consult a tax professional for details.
Once you have submitted payment we will reach out to you with a member form for our internal directory, and optionally for a public facing entry in our Member Directory.

Annual membership runs July 1 - June 30.
Which fiscal year are you paying for?

FY 2021-2022 FY 2022-2023
Name *

First Name Last Name
Email Address *
example@example.com
Institution, Agency, or Company Name (e.g. University of ..., NSF, etc.) *
Department, Institute/Center, Division Name (e.g. Center for ..., CISE, etc.)
Do we have your permission to list your Institution, Agency or Company and/or your Department, Center, or Division on a member list on our website? (your personal information will not be included)

Yes, both Just my Institution, Agency or Company Just my Department, Institute/Center, or Division No, neither
Would you like to be added to the ADSA mailing list to stay on top of ADSA events and activities? Email to this list is very limited, typically only ~2 emails per month. *

Yes, please sign me up! No, thank you I'm already on your mailing list
By checking this box, I acknowledge that I will abide by ADSA's Code of Conduct while engaging in any ADSA-sponsored activities or while representing ADSA. *

I agree

Member Options *

Student or Postdoc Membership

$ 50.00

Academic, Non-profit, or Government Membership

$ 200.00

All other Sectors Membership

$ 500.00

Enter coupon

Total

$ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Billing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Please verify that you are human *
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2022 Academic Data Science Alliance ~Individual Member Payment Form~