You must have JavaScript enabled to use this form. Basic Information Last Name First Name Gender Male Female Mailing Address Email Afliation (Department / Division / Company) Title/Position Phone Number Affiliations Faculty Staff Student Other If other, Please make your check payable to AFSSA and send it to: Professor Min-Lin Lo, AFSSA Treasurer Department of Mathematics (JB-370) 5500 University Parkway, San Bernardino, CA 92407 Office Phone: 909-537-5371 E-mail: Min-Lin Lo Membership Type Membership Type: Faculty/Staff/General ($25/yr) Student ($5/yr) Life time ($250) Paid By Cash Check Check Number Membership + Donation = Total Note: Any donation of more than $50 will be recognized in the AFSSA scholarship banquet brochure Received by Date Download Membership Application/Renewal Form