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ANS-SR Membership Registration
1.
Tell us about yourself!
Name
Address
City
State
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
Personal Email (
Preferred due to firewall blockage
)
Phone Number
2.
Where do you work? (Please indicate if you are retired.)
Company
City
State
Work Email (if personal email not provided)
3.
Are you an ANS National member?
Yes
No
(If yes, please enter your ANS number.)
4.
Why are you interested in joining the ANS-SR section?
Networking
Community outreach
Social and technical meetings
Continuing education
Other (please specify)
5.
Are you interested in volunteering? If so, what are your interests?
Section functions support
Executive committee
Community outreach
Other (please specify)
6.
Which local section committee or executive committee position are you interested in supporting?
Chair
Vice-chair
Secretary
Treasurer
Membership Chair
Publication Chair
Arrangement Chair
Public Outreach Chair
Programs Chair
CNTA liaison
Retiree liaison
Young members liaison
Other (please specify)