ONLINE MEMBERSHIP APPLICATION FORM

To become a member of the CSCA, first fill out and submit the online form below. You will then be asked to download and print a PDF version of our Statement of Faith (requires Adobe Acrobat Reader). Please sign your assent to the Statement of Faith, specify which membership category you have enclosed payment for, and mail this along with your payment to the CSCA. Once the CSCA receives this, your application will be reviewed and your membership confirmed.

Date:
First Name:
Initials:
Last Name:

Which Membership Category are you Applying For?
	New Promotional Membership
	Full Member
	Friend of the CSCA
	Associate Member
	Student Member
	Student Associate
	Retired Member
	Fellow
	Patron

Home Address:			Office Address:
Street Address:			Street Address:
City:			City:
Province:			Province:
Postal Code:			Postal Code:

I would prefer CSCA mailings sent to:

Home

Office

Home Phone:			Office Phone:
Would you like this number published in the ASA/CSCA Membership Directory? Yes No			Would you like this number published in the ASA/CSCA Membership Directory? Yes No
Fax:			Email:
Would you like this number published in the ASA/CSCA Membership Directory? Yes No			Would you like this number published in the ASA/CSCA Membership Directory? Yes No

Sex:

Male

Female

If married, please provide spouse's name:

Academic Preparation:
	Institution:	Degree:	Major:	Year:
1.
2.
3.

Field of Study (broad):
Concentration within Field (2 word limit):

Please describe your present or expected vocation:

How did your learn about the CSCA?

If you are an active overseas missionary, please give the name and address of your mission board or organization to qualify for complimentary membership.
Mission Board:
Street Address:
City:
Province:
Postal Code: