CLICK HERE FOR ON-LINE APPLICATION

MEMBERSHIP APPLICATION
___New Membership   ___Reinstate   ___Renewal

Address Information

First Name____________________M.I.___Last Name_________________

Mailing Address__________________________________________________

City___________________ State____Zip Code______Parish_____________

Office Phone (____) ______ Home Phone (____) _______Fax (____) _____

 Personal E-Mail______________________Business E-Mail_______________

Place of Employment__________________________________

University(if a student)_____________________________

Membership Dues
     
Membership in LCA means that you will abide by LCA's Bylaws and other governing documents, as well as the ACA's Code of Ethics, and are qualified for the membership category selected.
LCA Membership (Please select the dues category for which you are qualified.)

(  )  $50.00 Professional  Persons who hold a master’s degree or higher in counseling or a closely related field from a college or university that was accredited when the degree was awarded by one of the regional accrediting bodies.  Must hold a membership affiliation with at least one division.

(  )  $50.00 Regular    Persons whose interests and activities are consistent with those of  the Association but are not qualified for Professional membership.  Must hold membership affiliation with at least one division.

(  )  $30.00  Retired   Individuals who have previously been Professional members, but who are now retired from from the counseling profession.  Must hold membership affiliation with one division.

 (  )  $30.00  Student/Counselor Intern  Persons who have verified that they are enrolled at least half time as degree seeking  students in a counseling program in a regionally accredited institution; or an individual under supervision and not having received licensure.  A Counselor intern must be registered with the LPC Board. Must hold  membership affiliation with at least one division.

Division Membership Dues
Must join at least one division. Please check the appropriate membership type.

Louisiana School Counselor Association 
(___) Prof/Reg/Retired $10.00 (___ ) Student $ 5.00
Louisiana Association for Counselor Education and Supervision
(___) Prof/Reg /Retired $10.00 (___) Student $ 5.00
Louisiana Career Development Association
(___) Prof/Reg/Retired $ 5.00 (___) Student $ 2.00
Louisiana Association of Marriage and Family Counselors
(___) Prof/Reg $ 10.00 (___) Student/Retired $ 5.00
Louisiana Association for Spiritual, Religious, and Ethical Values in Counseling
(___) Prof/Reg/Retired $10.00 (___) Student $ 5.00
Louisiana College Counseling Association
-(___) Prof/Reg/Retired $ 5.00 (___) Student $ 5.00
Louisiana Association of Addiction and Offender Counselors
(___) Prof/Reg/Retired $ 5.00 (___) Student $ 3.00
Louisiana Association for Multi-Cultural Counseling and Development
(___) Prof/Reg/Retired $10.00 (___) Student $ 5.00
Louisiana Mental Health Counselors Association
(___) Prof/Reg/Retired $12.00 (___) Student $ 6.00
Association for Gay, Lesbian, & Bisexual Issues in Counseling in Louisiana
(___) Prof/Reg/Retired $ 5.00 (___) Student $ 5.00


Affiliate Membership Dues
Must join at least one division. Please check the appropriate membership type.

Louisiana Counselors for Social Justice
(___) Prof./Reg./Retired/Student  $5.00

Voluntary Contributions (Optional, but a great way to get involved.)
Research Trust Fund $__________ Legislative Trust Fund $___________
Scholarship Trust Fund $ _______ Legislative Action Fund $ _________

Include me in Blast Emails   ____Yes    ____No   Email address______________

Membership Dues Totals

LCA Membership $
Division(s) Membership
Contributions
Total Amount Remitted

.
Payment Method

(___)Check or money order payable to LCA enclosed.
          VISA ( _)           Master Card (__)
Account Number________________           Expiration Date______   V-code______

Authorized Signature_______________________________________________

Mail Registration Form with check payable to LCA or FAX with credit card information completed to 318-868-3341.   Direct questions to:

Diane Austin, Executive Director
Louisiana Counseling Association
353 Leo
Shreveport, Louisiana 71105
1-888-522-6362 (No calls after 9:00 P.M.)
FAX: 318.868.3341
Email:
lca@shreve.net

www.lacounseling.org