Capitalize Your Career

“Capitalize your Career” Capital of Texas Counseling Association A Chapter of the Texas Counseling Association Winner of the 2007-08 TCA Outstanding Chapter Award 2012-2013 Membership Application *CTCA website will be available soon through TCA website* Membership year begins July 2012 and ends June 31, 2013.

Name: ______Date: ______

Home Address: ______City: ______Zip: ______

Home Phone: ______Work Phone: ______

Email address: ______

Place of Employment: ______

What school district do you work for (if applicable)? ______

Is this a renewal membership? Yes _____ No _____ Are you retiring this year? Yes _____ No _____ Are you a member of Texas Counseling Association? Yes _____ No _____ Are you a Licensed Professional Counselor? Yes _____ No _____ If student, what college or university do you attend? ______

MEMBERSHIP & DUES Professional Membership for all members ------$20.00 Student Membership for enrolled college students------$15.00 Emeritus membership* is available to retired counselors after a minimum of one-year professional membership ------FREE

Please make checks payable to CTCA and mail them along with this application to:

Marilyn Johnson c/o Dripping Springs High School PO Box 479 Dripping Springs, Texas 78620

Payment Questions? Please e-mail Marilyn Johnson @ [email protected]

Membership Questions? Please e-mail Sylvia Chavez @ [email protected]

Chapter Questions? Please e-mail Melissa Fleming @ [email protected]

Cash: _____ Check: ____ Check Number: ______Rec’d date ______