Membership Application

First Name:

Middle Initial:

Last Name:

E-mail Address:

Position:

Institution:

Office Street Address:

City: State: Zip Code:

Work Phone Number:

Fax Number:

Please check here if you do NOT wish to be included in:

Institution Type (check ALL that apply):

Position Level:

Gender:

Ethnicity:

Are you a member of ACPA?

Are you a member of NASPA?

How long have you been a member of SCCPA? (years)

Have you been an SCCPA Board member?

If yes, please provide position(s) and date(s):

Please choose the functional area that best describes your position.

STANDING COMMITTEES

Please check any committee you are interested in serving

If you answered "Other" above, please explain below. Also, please feel free to submit any comments or questions below.

After you hit "Submit Application" below, you will be instructed to complete the application process by submitting your payment information.