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

Activity Director/Advisor Name::
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 Advisor
Name:
Position:
E-mail (you'll be added to our Advisor List Serve):
Approx. # of students:
Grades:
Does your school have a Leadership Class?	Yes No
Name of 2011-2012 Student Contact (optional)
Student Email:

Annual Fee:	$55.00
Additional Staff :	x $10.00/ea.
TOTAL AMOUNT DUE:	$
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.
We are sorry for the inconvenience but you will need to print and either mail or fax this form to: 503-334-1279. The OASC website is currently under construction!
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 Sara Nilles, Program Director
or call 503-480-7206.