LCSCA Membership Form
Beginning this year, LCSCA is moving to an online form instead of the paper form of the past to help streamline our data. Once you complete this form, be sure to mail in your membership dues, as your registration will not be complete until the money is received. When you mail a check, please be sure to add the "member name-school district name" in the memo line.
Email address *
First Name *
Last Name *
School District or Agency *
(or college for graduate students)
School Name (if you work in multiple buildings, list primary building. Leave blank if you do not work in a school)
School/Workplace- Street Address *
School/Workplace- Mailing City *
School/Workplace- Mailing Zip Code *
Home Address:
This year, with the potential for remote learning, we may be mailing out gifts or other items to school counselors. Please include your full home mailing address in case we are virtual. This information will be held confidential and not shared outside the LCSCA governing board.
Home- Street Address *
Home- Mailing City *
Home- Mailing Zip Code *
Preferred contact phone number (work or home) *
Assignment *
Required
Membership Status - PLEASE NOTE - In order for your membership to be active, you must mail your dues amount to Ephrata High School Atten: Steve Habowski 803 Oak Blvd, Ephrata PA 17522. Please be sure to add "member name-school district" in the memo line of your check to help us match up payment. If you have any questions, don't hesitate to call Steve at 717-721-1503 or Lori Casanova at 717-203-1554. *
Do you have any connections for locations that might consider hosting an LCSCA meeting, or a company who may be willing to sponsor one of our meetings?
If you have name and contact number for presenters, please include or bring to a board meeting.
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy