Membership Form

To join The Euler Society or to renew your membership, please print out this form, fill it in, and send it with a check for $25 US to:

Mary Ann McLoughlin
Department of Mathematics
College of St. Rose
432 Western Ave.
Albany, NY 12203

Use this same form and address to change your membership data.

Last name: _____________________________
First name or initial: _____________________________
Middle name or initial: _____________________________
Title: _____________________________
Address: _____________________________
City: _____________________________
State/Province: _____________________________
Postal Code: _____________________________
Country: _____________________________
Institution or affiliation: _____________________________
Office Phone: _____________________________
Home Phone: _____________________________
Email: _____________________________
Web site URL (optional): _____________________________

_____ check here if this is a new membership application

_____ check here if this is a membership renewal

_____ check here if this is to change your membership data