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Membership Application

Dues

DivisionsYou may join as many divisions as you like.

Divisions Total $

Total Amount Due $(Dues + Divisions)

Check all that apply: New Member Renewal Information ChangePlease print clearly so your information is printed accurately in our membership directory:

If you prefer, enroll online at: oklahomacounseling.org

Preferred Mailing Address:

Preferred Contact Number:   (           ) OCA Region:

Email Address:Please print clearly, this address will be used to send you newsletters and information.

NW C NE SW SE

Dr.  Mr.  Mrs.  Ms. (Last) (First) (MI)

(Number & Street) (City, ST) (Zip Code)

$50 Professional$30 Regular (Individuals in a counseling role with less than a master’s degree)

$0 Student (Individuals pursuing a master’s degree in counseling or closely related field. Students may now join for free. We still need your information to complete an application.)

$40 Retiree (Individuals retired from the counseling profession and receiving no compenstion for provision of services)

$10 Oklahoma Association of Addictions Counselors (OAAC)$  5 Oklahoma Christian Counselor Association (OCCA)$10 Oklahoma Association of Counselor Education & Supervision (OACES)$10 Oklahoma Mental Health Counselor Association (OKMHCA)$  5 Oklahoma Association for Multicultural Counseling & Development (OAMCD)$ 5 Oklahoma Professional School Counselors Organization (OPSCO)$  5 Oklahoma Association for Lesbian, Gay, Bisexual, & Transgender Issues in Counseling (OALGBTIC)$  5 Counseling Association for Military, Oklahoma Veterans and Families (CAMOVAF)

Make Check Payable To:Oklahoma Counseling AssociationMail Payment:Angela Easter3328 E. 7th St.Tulsa, OK 74112Questions: membership@oklahomacounseling.org

OCA Use Only:Received by:

Date:

2014 MembershipForm814-j