2006-2007
(Northern Kentucky Counselors Association)
The information below will be used for your membership record and directory:
Mr. Mrs. Ms. Dr. (Please Print)
Name:______________________________________________________________
Name of school or Agency: _____________________________________________
Address: ____________________________________________________________
City, State, Zip: ______________________________________________________
Phone: ______________________________________________________________
E-Mail: _____________________________________________________________
If you prefer to have newsletters sent to your home, or would prefer your home
address listed in the directory, please supply that information below:
Home address:
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Home Email__________________________________________________________
____I am enclosing a check for $15 for my 2006-07 membership fees. Payable to NKCA.
*Don't forget to check our web site at: www.poorehouse.org/NKCA/
Mail to: Cindy Sproehnle
Gateway Community and Technical College
1025 Amsterdam Rd
Covington, KY 41011