Individual and Student Membership Application Date: Name: Last Name: Mailing Address: City: Zip: County: Number: - - Work Number: - - Address: @ Please indicate type of membership you are interested in: Individual Membership $50/year Student Membership* $25/year * Full-time Undergraduate Student Only please indicate what year you will graduate: – ** Checks should be made payable to NCCASA Please return completed membership form with payment to: NCCASA Member Services 811 Spring Forest Road, Suite 900 Raleigh, NC 27609
Individual and Student Membership Application Date: Name: Last Name: Mailing Address: City: Zip: County: Number: - - Work Number: - - Address: @ Please indicate type of membership you are interested in: Individual Membership $50/year Student Membership* $25/year * Full-time Undergraduate Student Only – please indicate what year you will graduate: ** Checks should be made payable to NCCASA Please return completed membership form with payment to: NCCASA Member Services 811 Spring Forest Road, Suite 900 Raleigh, NC 27609