New York State Assessors' Association
Membership Application

Print this page, complete application and return with check or completed municipal voucher:

First Name:  
Middle Name:  
Last Name:  
Title: Sole Appointed Assessor [  ], Sole Elected Assessor [  ], Member Board of Assessors [  ], Chairman Board of Assessors [  ], Other [  ] Specify:________________________________________
Municipality or Firm:  
      Town [  ],     Village [  ],     City [  ],     County [  ]
County:  
Office Address:

  

Home Address:  
Office Phone:  
Home Phone:  
Fax Number:  
Email Address:  
Name of Spouse:  
Date of Birth:  
Local Newspaper:  
Person Referring: (If Any)  
   
REGULAR MEMBER:  $   85
ASSOCIATE MEMBER: Non-Government Employed  $ 135
ASSOCIATE MEMBER: Government Employed   $   85
ORGANIZATIONAL MEMBER: (Group Rates Available)  $ 425

UPDATED 10/08/2005
 
Make checks Payable to: New York State Assessors' Association  
Mail to: Thomas Frey, IAO  Executive Secretary, PO Box 888, Middletown, NY  10940
 
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