Coordinate/Affiliate Organization Application

Annual Coordinate Organization Reporting Form

Name of Organization*
Primary Organization Contact Person*
Contact Position within the Organization*
Personal Institutional Affiliation*
Contact Email Address*
Approximate Number of Members*
Membership Dues
*If there has been a change in your dues, please let us know as soon as possible.
Updated Website URL
*Please check the link associated with your Coordinate Organization on our website and update the url here if necessary.
Facebook URL
Twitter Handle
Instagram Handle
Other Social Media
Founding Year of the Organization
*Only requested if this is your org’s first report or you have a significant upcoming anniversary.
Organization's Mission Statement
*Will be printed in the ASA Annual Report.
Please provide the names and email addresses for your organization’s current or incoming officers for communication purposes.
Officer Position, Full Name, Email
PAST YEAR OVERVIEW AND NEW YEAR PLANNING
Please answer the following questions to the best of your knowledge and feel free to email the Coordinate Organization Liaison as a follow up for future arrangement.
List of Past Year Prizes/Awards & the Winners
Activity Highlights from the Past Year*
*Answers will also be printed verbatim in the ASA Annual Report unless editing for length is required. We may contact you for a feature in ASA News based on the information you share each year dependent on publication space.
Collaborations and/or Joint Initiatives
*If your organization has an idea for a collaboration or joint initiative with the ASA for the coming year, please let us know so we can contact you and plan ahead.
In what ways can the ASA help facilitate your organization?*
If you would like to request a meeting with ASA board members, please outline agenda items
Additional Comments (if any)
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Phone
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Annual Coordinate Organization Reporting Form

PAST YEAR OVERVIEW AND NEW YEAR PLANNING