C.D.S.C.A. TREASURER Carlos D. Rosa
CDSCA MEMBERSHIP APPLICATION*
(PLEASE TYPE OR PRINT ALL INFORMATION)
HIGH SCHOOL: _______________________________________________________________
SCHOOL ADDRESS: _____________________________ ZIP CODE: ____________________
SCHOOL TELEPHONE: ( ) __________________ FAX: ( ) _________________________
ADVISOR'S EXTENSION: _____________ SCHOOLS MAIL RUN #: ________ (CPS ONLY)
ADVISOR'S INFORMATION
NAME: _______________________________________________________________________
HOME ADDRESS: _____________________________________________________________
CITY: ___________________________________________ ZIP CODE: ___________________
TELEPHONE: ( ) __________________________ E-MAIL ADRESS: __________________
STUDENT COUNCIL PRESIDENT'S INFORMATION
NAME: _______________________________________________________________________
HOME ADDRESS: _____________________________________________________________
CITY: ________________________________________ ZIP CODE: ______________________
TELEPHONE: ( ) _________________________ E-MAIL ADRESS____________________
WAS YOUR STUDENT COUNCIL A MEMBER OF THE CDSCA LAST YEAR? ___ YES ___ NO
IF NO, WERE THEY EVER A MEMBER OF THE CDSCA ____ YES, IN ____________ (YEAR)
*THE MEMBERSHIP FEE IS ONLY TWENTY DOLLARS ($20) FOR THE 2004-2005 SCHOOL YEAR. YOUR MEMBERSHIP FEE INCLUDES:
- ATTENDANCE TO DISTRICT WORKSHOPS AT A REDUCED RATE.
- A SUBSCRIPTION TO THE CDSCA NEWSLETTER, THE WILD ONION.
- ELIGIBILITY OF ATTENDENCE TO THE ILLINOIS ASSOCIATION OF STUDENT COUNCILS 71ST ANNUAL CONVENTION.
MAKE YOUR CHECK PAYABLE TO:
CHICAGO DISTRICT STUDENT COUNCIL ASSOCIATION
SEND TO: CARLOS D. ROSA, CDSCA TREASURER
C/O MS. DANNA DOTSON
WHITNEY YOUNG HIGH SCHOOL
211 S. LAFLIN
CHICAGO, IL 60607