IlliAAC MEMBERSHIP APPLICATION
 Renewal
 New
Paying with  Cash  *Check # __________  **JV#___________
PERSONAL INFORMATION
Date __________________________________
Name: ____________________________________________________________________________________
Title:
____________________________________________________________________________________
Department: ______________________________________________________________________________
Campus address: __________________________________________________________________________
Campus phone number: ___________________________________________________________________
E-mail address: ___________________________________________________________________________
ADVISING EXPERIENCE
 Full-time professional
 Part-time professional
 Faculty
 Staff
 Graduate student
 Administrator
 Other (please specify) ___________________________________________________________________
Advising Level
 College
Advising caseload _____________

Department
students
Are you subscribed to the ADVIS-L Listserv?

N/A
Years of advising experience _____________

Yes

No
Are you a member of these professional advising organizations?
 NACADA  Great Lakes Region of NACADA  ILACADA
COMMITTEE PARTICIPATION
I would like to become a new participant in the:
I would like to continue to participate in the:








Assessment Committee
Membership Committee
Professional Development Committee
Technology Committee
Assessment Committee
Membership Committee
Professional Development Committee
Technology Committee
Please submit this application with your $15 membership fee to:
Kari Hutjens
Department of Economics
1407 W. Gregory Drive, 214 David Kinley Hall, MC 707
*Personal checks should be made payable to “IlliAAC”.
**If paying with a JV#, please be sure to use the following account number for IlliAAC:
905554-389005-307900-199000
Please include member name in description