Virginia Community Colleges Association Membership Application July 1, 2015

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Virginia Community Colleges Association Membership Application July 1, 2015– June 30, 2016

New Member *

yes

Name *

Position *

College *

Campus

College Contact

Office phone *

E-mail Address *

Curent VCCA position

Membership status *

Faculty & Adjunct Faculty Rank $25.00

Support Staff $25.00

Associate (Alumni, Board members, Friends) $5.00

What is your commission interest? *

Check all that apply

Black Concerns

Faculty/Instructional Affairs

Learning Resources

Public Relations & Marketing

Student Services

Support Staff

Required

As a member would you:

Check all that apply

Volunteer to be a college contact?

Volunteer to be an officer on the Executive committee?

Volunteer for an appointed position on the Executive Committee?

Make Check Payable to: VCCA Please give your check and registration form to your College Contact so all registrations may be mailed together.

Mail to:
Becca Linkswiler, CPPB, VCO
Procurement Officer
Dabney S Lancaster Community College
P.O. Box 1000
1000 Dabney Drive
Clifton Forge, Va 24422
If you have questions concerning this form please email blinkswiler@dslcc.edu

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