2012-2013
Membership Application
Name:
Dr.?
First
Middle Initial Last
(if desired)
Title:
College: STLCC
Campus (if applicable):
Phone Number:
E-Mail Address:
Membership category:
Individual. Open to current Missouri community college employees and trustees. Annual dues: $30.
Associate. Open to individuals whose professional or educational activities are closely related to the functions and purposes of Missouri’s community colleges, or that
support the aims and activities of the Association. Associate members are not voting members of MCCA. Annual dues: $30.
Retired. Open to retired Missouri community college employees. Annual dues: $15.
Student. Open to current Missouri community college students. Annual dues: $10.
Life. Available to any person who is eligible for individual membership. Lifetime dues: $300.
Life Retired. Available to any retired Missouri community college employee. Lifetime dues:
New MCCA member
Status:
$150.
Check the size you would
like.
Renewing MCCA member
Administrative/Professional
Faculty
Retired
Department:
 Yes! I would like an
MCCA t-shirt!
 Small
Associate Member
Life
Student
Classified Staff
Life Retired
Trustee
 Medium
 Large
 Extra Large
 XX-Large
Want to be an advocate for community colleges?
I want to receive legislative updates during session.
Contact me when MCCA needs help in the Capitol.
Interested in networking with colleagues who have similar jobs?
A+ Coordinator
Arts & Humanities Faculty
Chief Financial Officer
Human Resources Office Staff/Administrator
Marketing/PR/Web Design Professional
President/Chancellor
Academic Advisor
Bookstore/Auxiliary Services
Counselor
Institutional Researcher
Math & Science Faculty
Registrar’s Office Staff
Check the term(s) that best describe(s) your position. (Optional.)
Administrative Assistant
Business Office Staff
Dean
Instructional Designer
Nursing/Allied Health Faculty
Social Sciences Faculty
Other:
Admissions Office Staff
Career/Tech Ed Faculty/Staff
Department Chair
Internship Coordinator
Part-Time/Adjunct Faculty
Student/Campus Life
Professional
Alumni & Development
Chief Academic Affairs Officer
Financial Aid Officer
IT Staff
Physical Plant/Grounds Staff
Workforce Development
Professional
Method of Payment – St. Louis Community College
Check
Make checks payable to the Missouri Community College Association in the amount of $30.
Credit Card
MasterCard
Visa
Card Expiration Date:
Card-Holder’s Name:
Payroll Deduction
Card Number:
Available only to current college employees. Not available to associate, life retired, or retired members.
By signing below, I am authorizing payroll deduction.
_________________________________________________________ __________________________________________ ___________________
Signature
Employee ID Number
Date
RETURN COMPLETED APPLICATION AND DUES TO YOUR CAMPUS MEMBERSHIP COORDINATOR,
DIANE WHITESIDE
FOR MCCA
USE ONLY
Date Received
Check #
Batch #
Authorization #