Annual Membership Form
(12 Calendar Months)

• Active: Individuals actively participating in Child Welfare and Attendance or related work.
• Retired: Individuals who have participated in Child Welfare and Attendance or related work.
• Student: Individuals enrolled as students working towards a Pupil Personnel Services Credential with CWA emphasis.
• Honorary Life: Nominations are made by the sections for ratification by the Executive Board of the Association

Section Affiliation
Bay __________  Delta __________ San Joaquin __________  Southern _________
Membership Information
New Member _____    Renewal _____ 
Date ______________________________
Last Name ________________________________________________________________
First Name ________________________________________________________________
Address __________________________________________________________________
City, ST & Zip _____________________________________________________________
County ___________________________________________________________________
Employment/District ________________________________________________________
Title/Position ______________________________________________________________
Your E-Mail _______________________________________________________________