Nebraska Council of School Administrators
2008-09 Online Membership Form and Invoice

DIRECTIONS: The following online form may be used by
both new and renewing members. Please complete the
form and press "Submit Form" at the bottom of the form. Be sure to print a copy of the form to use as an invoice.

NOTE: Fields marked by (*) are required.

Membership year begins September 1 - August 31


Total: $0.00


Back to
NCSA Site
1. Please Check Status*


2. Full Name (Title, First, MI, Last)*

3. Informal First Name (e.g., "Bob" for "Robert")

4. Maiden Name

5. Position Title*

6. School District Name*

7. School Building Name (if applicable)

8. School Enrolled in (if applicable)

9. Work Street Address*

10. Work City/State/Zip*

11. County in which school is primarily situated*

12. NCSA Region

13. Work Phone*
( ) -

14. FAX number
( ) -

15. Home Street Address

16. Home City/State/Zip

17. Home Phone
( ) -

18. E-mail Address (very important)*

19. Select classification which best describes your position: (used for record/data sorting)*

20. NCSA Membership Classification (check one of the following)*

($325)
($100)
($30)
($170)

21. NCSA Affiliate Association (all members must check one of the following)*






22. National Association Membership(s) (optional, except for ** NAESP membership)
NCSA acts as the intermediate for all the national organizations. Please be sure to submit your national membership through NCSA, rather than going directly to the national organization.

($403)
($215)
($226)
($185)
($183)

**Association dues are not deductible as charitable contributions for tax purposes, but 50% of NCSA dues may be deducted as a business expense.

23. National Membership Number

24. Check method of payment*






**No memberships will be activated until payment is received.

25. To which address do you prefer to receive mail from NCSA?*



STOP! Before you click "Submit Form", please print a copy of the completed form/invoice to give to your business office. No additional invoices will be sent.

NOTE: Fields marked by (*) are required.

All checks payable to "NCSA"
* Member's name must appear on check *

Payments and forms may be mailed to:

NCSA
455 S. 11th St., Suite A
Lincoln, NE 68508

(402) 476-8055
(800) 793-6272
FAX: (402) 476-7740