Oregon Association of Student Councils

Please fill out this form and submit it online or print it and send with payment to:

OASC
707 13th Street SE, Suite 100
Salem, OR, 97301-4035

Name of Rep. to receive mailings:
Title:
School:
Address:
City, ZIP:
Phone number (with area code):
FAX number (with area code):
E-mail (you'll be added to our Advisor List Serve):
Additional Staff @ $10.00/ea.
1. Name:
Position:
2. Name:
Position:
3. Name:
Position:
4. Name:
Position
5. Name:
Position:
Does your school have a Leadership Class?	Yes No

Annual Fee:	$55.00
Additional Staff :	x $10.00/ea.
TOTAL AMOUNT DUE: ($55 + $10/ea. additional staff)	$
PAYMENT METHOD:	Enclosing Payment (print and mail this form) Bill School, P.O.# Bill District, P.O.#
District:
Address:
City, ZIP:
If you have a Purchase Order number and wish to be invoiced, you may submit this form online.
Security Code:
Please enter the security code you see above in this box:

If you would like to send payment with your membership form, please print this form and mail to the address below.

Mail to: OASC 707 13th Street SE, Suite 100 Salem, OR 97301-4035

Questions? Contact Nancy Moen, Program Director
or call 503-480-7206.