CDCA Membership Form 2011-2012

You will see a printable confirmation page after completing this on-line form. 

 

PLEASE NOTE:  After completing this form you will need to pay for membership through PayPal. 

If you prefer to pay by purchase order or check, print your confirmation page and mail with payment to:

                     CDCA Membership, PO Box 13174, Albany, NY, 12202.

 

Today's date:

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Please provide the following contact information: (*required)

*First Name
*Last Name
Title
*Organization
*Mailing Address
Address (cont.)
*City
*State
*ZipCode
Country
Work Phone
Home Phone
Cell Phone
FAX
*E-mail

Please indicate your worksite(s):

College Admissions         College Counseling or Career Center   Counselor Educator
Graduate Student           Elementary                            Middle School
High School                District-wide                         Community Agency 
Retiree                    Other

Please indicate committee(s) you would like to join:

Administrative Assistant Luncheon  Archives                      College Fair            
College Caravan                    College Bus Trip              Elementary School Counselors 
Middle School Counselors           High School Counselors        Legislative                        
Newsletter                         Retirees                      Scholarships                     
Sunshine                           Website

Please indicate the appropriate membership category:    PLEASE NOTE:  Our membership year is July 1 - June 30

Please indicate how you will be paying:


Capital District Counseling Association - Copyright © 2010 CDCA. All rights reserved.  Revised: 01/11/12