Nebraska Council of School Administrators
2013-14 Online Membership Form and Invoice

DIRECTIONS: The following online form may be used by both new and renewing members.
Please complete and press "Submit Form" at the bottom.

NOTE: Fields marked by (*) are required.

Membership year begins September 1 - August 31


Total: $0.00



Back to
NCSA Site


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

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

($335)
($235)
($125)
($40)
($250)

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

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

5. Maiden Name

6. Position Title*

7. School District Name*

8. School Building Name (if applicable)

9. School Enrolled in (for student membership only)

10. Work Mailing Address*

11. Work City/State/Zip*

12. County in which school is primarily situated*

13. NCSA Region

14. Work Phone*
( ) -

15. Cell Phone (optional if you desire to receive text updates)
( ) -

16. FAX number
( ) -

17. Home Mailing Address

18. Home City/State/Zip

19. Home Phone
( ) -

20. E-mail Address*

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

22. NCSA Affiliate Association (this is your primary affiliate)*






23. Additional Affiliate Association (optional to receive news from one other affiliate)

24. National Association Membership (optional)
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.

($436)
($235)
($250)
($211)
($189)

25. National Membership Number
 (Please enter number if known)

26. Check method of payment*






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




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