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)
BASIC MEMBERSHIP
□WCA+WASERVIC □WCA+WSACES □WCA+WAMCD □WCA+WCDA □WCA+WSCA
□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 _________________________
STUDENT VERIFICATION
(required for all student members)
College/University _______________________ Professor’s Signature________________________________
□ Send membership directory