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Registration 2024
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New Jersey College Counseling Association
Membership and/or Conference Registration
1) Start by filling out the form below. You can pay now or pay later (up to and including the date of the conference!)
2) Even if multiple people are paying together, this form should be completed for
each person.
3) Clicking the "Submit" button at the bottom of your completed form will automatically take you to payment options. Note: Should there be no response to "Submit" be sure to check for incomplete required fields (appear as red boxes). You need to click "Submit" to register , even if you not plan to pay now.
4) If you (and your staff) have already filled out this form and just want to pay,
click here
. New this year: An online payment option called
Square
(the link "Pay now by debit or credit card" takes you to our
Square
site).
Membership runs from May 1st through April 30th of each year. You may renew your membership and receive the conference discount using this form.
Registering by April 25, 2014 avoids a $5/person late registration fee.
Items marked with asterisk
*
are required.
*
Indicates required field
Select One
*
Conference and Membership
Conference Only
Membership Only
You may apply for or renew membership while registering for the conference at the same time.
Name
*
First
Last
Email
*
Preferred email for correspondence.
Institution (University or College Name/Private Practice/Other)
*
List "Private Practice" or other relevant info if you do not work at a college or university.
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Preferred Mailing Address
Preferred Phone Number
*
Office Phone Number
*
Phone Extension (if needed)
*
Website (Personal or Department)
*
Job Title/Position
*
Short description or title of your job or position at the institution where you work. For independent practice list your profession. E.g. Clinical Social Worker, Director of Counseling Services, Career Counselor, Psychologist, Graduate Student, Postdoctoral Trainee, etc.
Interests/Specialties
*
Anything you want to appear in the members directory.
OK to share the above information with other members?
*
Yes. (I'd love to have other members be able to reach me.)
No.
Membership and/or Conference Registration
Membership Category
*
University Affiliated
Associate (Private Practice/Other)
Retiree
Membership Type
*
$25 Professional Membership
$10 Student Membership
No Membership at this Time
Select "No Membership" if you have already achieved nirvana and have no need to hear scintillating comments and questions from other university and counseling professionals.
R
egistration
Prices below include your $5 late (after April 25th) fee.
Conference Registration
*
$80 Member
$95 Non-member
$40 Students
Not registering for conference - Membership only
Registering for membership now gives you a membership discount immediately. $5 Late Fee required for Conference Registration after April 18th.
Add me to the NJCCA ListServe
*
Yes!
No.
Yes means you will receive announcements and postings by NJCCA members. You will also be eligible to post yourself.
Student Members complete this section
Degree Being Sought
*
NA
Bachelors
Masters
Doctorate
College or University
*
Program or Major
*
Anticipated Graduation Year
*
Professional Members complete this section
Degree and Field
*
For example: Ed.D. - Counseling Psychology
Program/University for Highest Degree
*
Year Degree Conferred
*
License type (if applicable)
*
NA
Psychologist
Professional Counselor
School Psychologist
Clinical Social Worker
Alcohol and Drug Counselor
Marriage and Family Therapist
License number (if applicable)
*
If applicable.
Submit