LCCA 2023-2024 Membership Form
  1. If you are completing this form, you must pay by PAYPAL. The QR code is at the bottom of this form. 
  2. If you would like to pay by check, please use the paper form HERE
Sign in to Google to save your progress. Learn more
Email *
Last Name *
First Name *
School or Agency *
Phone Number
Do you have suggestions and/or topics for future workshops or activities?
PayPal Option for Payment -  $30 for counselors and $10 for Students/Interns).  Registration is NON-REFUNDABLE.  Thank you.
Payment type *
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Adlai E. Stevenson High School, District 125. Report Abuse