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 2021-2022FY 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, bothJust my Institution, Agency or CompanyJust my Department, Institute/Center, or DivisionNo, 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 youI'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~