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GKCSCA Electronic Membership Form 19-20
Please fill out the following form to join the Greater Kansas City School Counselor Association!
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* Indicates required question
Last Name
*
Your answer
First Name
*
Your answer
School District or Agency
Your answer
School Building
Your answer
Position
School Counselor
Other:
Clear selection
School Address
Your answer
School Phone
Your answer
School County
Your answer
School Email Address
Your answer
Residence Address
Your answer
Residence Phone
Your answer
Residence Email Address
Your answer
Membership
NEW GKCSCA Member
Renewal Membership
Other:
Clear selection
Membership In (check all that apply)
ACA
ASCA
MSCA
ACTE
MOACTE
Other:
Level
*
Elementary
Middle/Junior High
Secondary
Multi-Level
Placement Coordinator
Other:
Membership Type
*
Professional (Counselors & Instructors) $15
Student, Retiree, & Affiliate $5
Payment
*
PAYPAL (please logon to Paypal and pay fees to
gkcschoolcounselors@gmail.com
, select "pay family or friends", please make note of who you are paying for)
CHECK (please make check out to GKCSCA and mail to GKCSCA c/o Jill Krickbaum, 962 E. Cavendish Trail, Olathe KS 66061
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