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:
-
-
Evening:
-
-
Fax:
-
-
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)
Periodically NACADA distributes mailing lists
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.
Institutional
Membership:
$200.00 for Official
Representative
To apply for an institutional membership, please complete and
return an application form for each
"Official/Additional Representative". Mail completed
forms together in one envelope with
payment.
$100.00 for Each Additional
Representative
METHOD
OF PAYMENT:
Check
Enclosed
Purchase Order
Visa
Master Card
American Express
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.
