Lake County Counselors Association Membership Form 2011-2012
Please print this page and mail it with your $20.00 check ($5.00 for Students) payable to
Lake County Counselors Association to:
Carol Seeger
Stevenson High School
One Stevenson Drive
Lincolnshire IL 60069
847-415-4534
cseeger@d125.org
Name________________________________________________
School or Agency_______________________________________
Address_____________________________________________
Phone________________________ Fax______________________
E-mail address___________________________________________
Contact info will be posted on the website.
Are you a member of?
____ American Counseling Association
____ Illinois 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?
______ Student/Intern
_____ 0-2 years
_____ 3-5 years
_____ 5-10 years
_____ Over 10 years
Do you have suggestions and/or topics for future workshops or activities?
Print PDF