INVOICE
Institutional Membership Dues
September 2005- August 2006
(Fill out form below, print, & mail)

Institution

Director's Name

Title/Office

Mailing Address

City & State

Zip Code  


E-mail

(Area Code) Telephone Number

Amount Due*: $

Please make checks payable to:
Texas University & College Counseling Directors’ Association

(Vendor ID#: 30006506841000)
(Tax ID#: 75-2807465)

Please remit by 12-15-2005

Mail To:
Ken Farr, Ph.D.
Tuccda Treasurer
UTA-Counseling, Learning, and Career Services
P.O. Box  19156
Arlington, TX 76019

* Dues Structure:

• Institutional enrollment less than 10,000 students ... $50.00
• Institutional enrollment 10,000 students or more … $75.00
• Affiliate member … $5.00