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ASJA Membership Application

Section 1: User Information
	First Name*

Last Name*

Institution*

Title*

Address*

Address 2

City*

State*

Zip Code*

Country

Phone*

Fax

E-mail*

E-mail 2

Web Site

Gender

User Name

Password

confirm password

Section 2: Membership Information
	Ethnicity	SELECT ONE White-Non Hispanic African American American Indian Asian American Hispanic Multi Ethnic Other

Tribal College

Yes    No

Histoical Black College   Yes    No

Institution Type

SELECT ONE Community College Private - 2 year Private - 4 year Public - 2 year Public - 4 year

Circuit

SELECT ONE Canada Circuit 1 Circuit 10 Circuit 11 Circuit 2 Circuit 3 Circuit 4 Circuit 5 Circuit 6 circuit 7 circuit 8 Circuit 9

	Number of Total Students

	Referral Source or Member Name

Section 3: Membership Type
	Membership Type* $190.00 - Professional - 2 years $100.00 - Retiree - 2 years $80.00 - Student - 2 years $95.00 - Professional Membership $40.00 - Student Membership $50.00 - Retiree $475.00 - Corporate Affiliate $140.00 - Limited Individual $190.00 - Association Affiliate

Section 4: Payment
	Payment Method*     Credit card     Check

For security reasons, type in the code below:

About ASCA

We who administer conduct standards for students at institutions of higher education recognize that a personal sense of honor sustains both individuals and their communities. To this end, we have formed the Association for Student Conduct Administration (ASCA),to foster the following principles, read more >>

ASCA Membership

Member benefits include:

• Annual Conference
• Donald D. Gehring Academy
• Career Center/Job Listings
• Drive in workshops/conferences
• Leadership Opportunities

Learn more about ASCA Memberships »

Join today! »