top left corner image
top right corner image

SCSCSW Renewal Membership Application


Please fill in all applicable fields below.

OR... if you prefer, you may download the renewal membership form, print it, and send a copy to Leigh Bostic along with a check made out to "SCSCSW".

Questions?
Contact Membership Chair, Leigh Bostic
Email: membership@scclinicalsocialwork.org
Phone: (864) 430-0475
Fax: (864) 298-8032 - attn: Leigh Bostic

All supporting information should be sent to Leigh Bostic after submitting the form.

First Name:
Last Name:
Work Title/Position:
Organization:
Preferred Email:
Preferred Mailing Address:
City:
State:
Zip:
Phone (work):
Phone (home):
Level:
Practice modality or special interests (to be included in membership directory):


Every member is encouraged to serve on a committee. Please indicate interest(s):
Education Finance Public Relations
Ethics Nominations
Government Affairs Membership


Membership Category:
I wish to receive a $15 discount on membership by accepting all SCSCSW correspondence electronically (email and website).
I wish to deduct an additional $35 from my SCSCSW membership fee by sending a current copy of my CSWA membership certificate to Leigh Bostic. (NOTE: If you join or renew with Clinical Social Work Association within the next year, you may submit a copy of the membership certificate at that time and be reimbursed $35.)
Check here to indicate that you need a certificate of membership (if your status has changed or if you don't have one).

Total Membership Cost:


bottom left corner image
bottom right corner image
© 2012 South Carolina Society for Clinical Social Work    |    Website by  Bunk Design logo