NACADA
Executive Office, Kansas State University
2323 Anderson Avenue, Suite 225
Manhattan, KS 66502-2912
First Name:
Initial:
Last Name:
Job Title:
Institution:
Address:
City:
State:
Zip Code:
-
Country:
Day Phone:
-
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Evening:
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-
Fax:
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Email Address:
All NACADA communication
is done ELECTRONICALLY; therefore, it is essential we have your
email address for you to receive the NACADA Newsletter or other
communication.
Role:
(Check one)
Gender:
(Optional)
Faculty Advisor (FA)
Female
Academic Advisor/Counselor
(PA)
Male
Advising Administrator
(AA)
Counselor (CN)
Non-Institutional (NI)
Other: (OT)
Ethnic
Background: (Optional)
Age:
(Optional)
African American/Black
Birth Year
Native American
Hispanic/Latino
Asian American
European American/White
Other
YOU
MAY CHOOSE A TOTAL OF FOUR (4) OF THE FOLLOWING:
Use
of Information: (To be excluded, check the box)
Mailing lists periodically distributed to other
educational entities.
Joining
or Renewing NACADA Membership: (Select one)
March - March
September - September
You may change your
membership year but a lapse in membership could make you ineligible
for elected leadership positions and certain awards.
Individual
Membership (General or Associate):
$55.00 - General - members employed
by accredited, non-profit higher education institutions
$75.00 - Associate - members not
employed by accredited higher education institutions
METHOD
OF PAYMENT:
Check
Enclosed
Purchase Order
Visa
Master Card
American Express
Discover
Card
Number
-
-
-
Expiration
Date:
/
Cardholder
Name:
NOTE: Checks must be on a U.S. Bank in U.S. Dollars,
payable to NACADA. A $15 service fee for returned
checks applies. NACADA's Federal Employee Identification
Number (FEIN) is 48-1114759
NACADA Executive Office
Kansas State University
2323 Anderson Avenue, Suite 225
Manhattan, KS 66502-2912
Phone: (785) 532-5717 Fax: (785) 532-7732
e-mail:
nacada@ksu.edu
