2026-2027 ICCSAA Membership Form

2026-2027 ICCSAA Membership Form
Please complete this form by September 15, 2026.

The yearly cost to be an ICCSAA Member is $150. This covers membership for all staff members at a single institution.

Payment can be sent separately and is due by Novemberber 1, 2026. You can pay for membership 3 ways:
1. Online at www.paypal.me/ICCSAA
2. With a check payable to ICCSAA and sent to:
  - Genny Stevens, Coordinator of Student Life Carl Sandburg College
    2400 Tom L. Wilson Blvd. Galesburg, IL 61401
3. Use the attached invoice in the response email after submitting this form and have your institution send a check to:
  - Genny Stevens, Coordinator of Student Life Carl Sandburg College
    2400 Tom L. Wilson Blvd. Galesburg, IL 61401
If you have any questions, please contact Jelymar Mejia at mejiaj742@cod.edu.
Date

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Institution
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Email
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Additional Staff Information
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