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2023-2024 HCA Membership Form
Membership period is from year to year. You may join or renew your membership at any time.
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* Indicates required question
Preferred
email
for HCA communication:
*
Your answer
Last Name
*
Your answer
First Name
*
Your answer
Preferred
Phone
Number:
*
Your answer
PREFERRED MAILING ADDRESS FOR HCA COMMUNICATION
:
Number and Street Name, Apt or Suite #
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
MEMBERSHIP CATAGORY
Fees:
Professional - $25
;
Student - $10
;
Retired - $15
*
Choose
Professional
Student
Retired
BUSINESS, AGENCY OR SCHOOL DISRICT
Name of Business, Agency, or School District
*
Your answer
Name of Department or Campus
Your answer
SUPERVISOR
Are you an LPC-S who would like to supervise?
Yes
No
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DIRECTORY
Print my contact information in an HCA Directory?
*
Choose
Yes
NO
OTHER PROFESSIONAL ORGANIZATIONS:
Choose Current Memberships
ACA
TCA
ASCA
TSCA
Other:
COMMITTEES
Please consider volunteering to help with one or more of the following:
Professional Development
Member Recruitment (August)
Community Service
Social Media/Website
Silent Auction (December dinner)
Hospitality
Scholarships (Spring semester)
Awards (February-April)
Newsletter/Public Relations
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