Please Print this
page and mail with your $20.00 check (payble to: Lake
County Counselors Association) to:
Name____________________________________
School or Agency______________________________
Mailing Address___________________________________
___________________________________________
Phone________________________
FAX__________________________
e-mail
address______________________________________________
Are you a member of:
____ American
Counseling Association
____
____ Other
Professional Organizations ______________________________
Are you interested in serving on the Executive Board of LCCA? ____ Yes
____ No
How many years have you been working as a counselor?
_____ 0-2 years
_____3-5 years
_____5-10 years
_____ over 10 years
Do you have suggestions for future workshops or activities?