WCA Membership Application

Send to:  Pam Van Der Does, WCA Membership Services
7631 W Idaho Street, Rathdrum, ID 83858
Email [email protected], Phone 208.755.6121

Membership Application and renewal form
(95% of dues is tax deductible)
Professional/Associate, Basic ($72)               Professional/Associate, WSCA 2-yr special ($134)    

Student/Retired, Basic ($35)                                                     □ Student/Retired, WSCA 2-yr special  ($60)
Organizational (call for details)    

NOTE NEW DIVISION: Washington Counselors for Social Justice (WCSJ)


WCA+WAAOC     WCA+Mental Health   WCA+WCSJ

Additional Division(s) ($10.00 each, per yr)
WASERVIC   □WSACES    □WAMCD   WCDA     □WSCA   WAAOC     Mental Health    □WCSJ
PAYMENT ENCLOSED (check or money order, payable to WCA in US funds)  
CHARGE my    □ VISA     MC   ($3 surcharge for credit card processing)           
Payment in full                                                                                   Installment Option
1st check, $24 ($45 2-yr) + additional divisions
2nd & 3rd checks postdated, $24 ($45 2-yr) each, consecutive months

Card # ____________________________Exp. ______Signature___________________________________

Name on Card ____________________________________

Name ___________________________________Address________________________________________

City ________________________ State _______ Zip _________ Email______________________________

Home Phone # __________________ Work Phone # ____________________ Fax # ___________________

Preferred  Home  Work   Highest degree earned_____   Date_____ Specialty _________________________

(required for all student members)

College/University _______________________ Professor’s Signature________________________________

Send membership directory                                                  


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