NYS ATSA Membership Form

NYS ATSA
PO Box 3117
Albany, New York 12203

www.nysatsa.com
nysatsa@gmail.com

Member Information

Please complete the following information to become a NYS ATSA member. Annual membership dues for NYS ATSA are $35.00. Student memberships of $20.00 are available for full-time students (proof of full-time student status is required and will be requested). Membership dues are for May 1 - April 30. In order to become a NYS ATSA member, you must already be a member of National ATSA. If you have any questions about membership, please contact nysatsa@gmail.com.

* First Name

* Last Name

* Credentials

* Title

* Organization

* Address 1

Address 2

* City

* State

* Postal Code

Phone

Fax

* Email Address

I am currently a member in good standing with National ATSA and would like to join NYS ATSA.

Yes, I would like to join NYS ATSA ($35)

Yes, I am a full-time student and would like to join NYS ATSA as a student member ($20)

I am already a member of NYS ATSA and would like to renew my 1-year membership. I am currently a member in good standing with National ATSA.

Yes, I would like to renew my NYS ATSA membership ($35)

Yes, I am a full-time student and would like to renew my NYS ATSA student membership ($20)

Comments:

* Indicates Response Required