Application for Student MTCA Membership

Contact Information

First Name

Last Name

College, University, or Educational Inst. at which you are completing your studies

Degree program in which you are currently enrolled

Anticipated Date of Graduation

Date of Birth (student members must be at least 21 years of age)

Phone

Ext.

Address

City

State

ZIP

Interest in Collaborative Process

Please describe your interest in the collaborative process and how you found MTCA.

Collaborative Training

Have you participated in a two-day introductory collaborative training sanctioned by the IACP or any other collaborative educational event? If so, through what organization did you complete your training and when did you complete your training?

Membership Dues

Dues for Student Members are $25 annually.

Agreement

As a Student Member of MTCA, I agree to abide by all of the Membership Requirements of MTCA and will not use or share member contact information to which I may have access for purposes of advertisement or selling. I also agree that I will not use the MTCA logo in any form, including, but not limited to, in promotional materials and resumes, but I may use freely “Student MTCA Membership”.