Passaic County Community College

Membership Form

Dues must be paid by October 12, 2011. Send your $25.00 check payable to PCSCA with this form to:

Monica Mann
Wayne Hills High Schhool
272 Berdan Avenue
Wayne, New Jersey 07470

Your dues must be paid by October 12 even if you are not attending the October 18 dinner at Macaluso's. If you are going to attend the dinner, you must RSVP by October 12th by returning your membership form and $25.00 check.

YOU CANNOT PAY AT THE DOOR!!

When returning membership form before the October meeting please include the RSVP form on the following page

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SCHOOL CONTACT INFORMATION

Name
School Name
Street Address
City
State
ZIP
Work Phone
School E-mail Address **
Title/Position
HOME CONTACT INFORMATION
	Street Address
City
State
ZIP
Home Phone
Fax #
Home E-mail Address **	** All meeting reminders will be via email. If you do not have an email address please make sure you note that on your membership paperwork.
Position	Counselor - Regular Member Elementary College Admissions – Associate Member Counselor – Regular Member Middle School Graduate Student Counseling Field – Associate Member Counselor – Regular Member High School Other active educational personnel-Associate Member Please list position Guidance Director - Regular Member Retired Counselor – Associate Member If there are new counselors in your school or district, please PHOTOCOPY and SHARE the Membership Information Form with them. Should you have any questions or concerns contact membership chair Monica Mann at 973-317-2029 or 2030.
	I WlLL attend the October 18, 2011 meeting at Macaluso’s. I WILL NOT attend the October 18, 2011 meeting at Macalusos. My $25.00 Dues are enclosed. I have paid my dues online at the NJSCA website. (please check if you will or will not be attending the October 18th meeting on the lines above). Remember, every meeting is important and the success of this organization depends on your participation. Please attend every meeting.