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A CHAPTER OF THE NEW YORK STATE COUNSELING ASSOCIATION
 

MEMBERSHIP APPLICATION
2007 – 2008
 DOWNLOAD MICROSOFT WORD DOCUMENT

 You may complete and submit your membership application online or download a Microsoft Word version of the application. If you submit the online form, please send a copy of your confirmation along with your dues to CDCA, PO Box 13174, Albany, NY 12212. Make the check payable to CDCA. If you have any questions about membership, email Colleen Pacella, CDCA Membership Chair.

  • Date:  -- mm/dd/yy

  • Select:

    New Member      Renewal

  • Please provide the following contact information (*required fields):

    * First Name  
    * Last Name  
    Title
    * Organization  
    * Street Address  
    Address (cont.)
    * City  
     * State/Province  
    * Zip/Postal Code  
    * Work Phone  
    Home Phone
    FAX
    * E-mail  
    School Website

  • Select the following interests that apply:

     College Fair    Elementary School Counselors   High School Counselors   
  Legislative  Membership   Middle School Counselors 
 Newsletter/Publications   Nominations/Elections            
 Programs/Professional Development  
 Publicity/Public Relations   Scholarships   
Strategic Planning   Sunshine

  • Are you a member of the New York Counseling Association (NYCA)?   Yes No

  • Are you a member of the American Counseling Association (ACA)?      Yes No

  • Membership Dues Membership year July 1, 2007 – June 30 - 2008:

    Regular Member (One Year)   $20
    CDCA Retired Member   $10
    Student Member  $10
    Emeritus Member