American Statistical Association
Award for Outstanding Chapter Service Form


Please complete the form below no later than 4:00 PM (EDT) on April 22. Forms received after this date are not guaranteed to be included in the Presidential Address program booklet. Should you have any questions, please contact Rick Peterson at rick@amstat.org.

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Recipient Information
Name of Recipient
Address
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Certificate Information
Name of Chapter
Name of Award
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Note: All certificates will be signed by the Council of Chapters Governing Board Chair and the ASA President. Certificates will not be placed in holder to allow others the chance to sign if desired.
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Questions, email rick@amstat.org