I - Registration Information

Name - First, (Nickname), Middle, Last *

Primary Phone *

Type *

Email Address

Mailing Address *

City *

State *

Zip *

II - Registration Fees

Note: All counselors or counseling related attendees are expected to join ALCA prior to registration for the conference. Others pay the Non-Member fee.

Please choose one of the boxes below:

Fees for registrations after November 1st:

Member - Regular/Professional - $135

Member - Student (Not working in counseling) - $70

Member - Retired (Not working in counseling) - $70

Non-Member - $235

Students Only - By checking the box below, I certify that I am a full-time student and not working full-time in counseling. Enter the name of the student's institution and professor in the fields provided.

I am a full-time student, not employed in counseling

Institution

Professor