Institutions wishing to purchase memberships in bulk for their new or continuing students may do so at a $10/year discount from the normal rate of $47. With bulk student membership, the cost is $37 per student member. Credit card payment is due upon form completion. A receipt will automatically be emailed to you.

This form is intended for purchase of 5-30 student memberships. Please contact lsa@lsadc.org if you are registering more than 30 students or have questions about a small student group.
Primary Contact Information
Please provide the requested information for the person who will serve as the primary contact for your group membership. The primary contact will serve as the main point of communication for any questions related to this form submission or payment.

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1. Primary Contact First Name: (Required.)

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2. Primary Contact Last Name: (Required.)

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3. Primary Contact Job Title: (Required.)

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4. Primary Contact Email Address: (Required.)

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5. Primary Contact Phone
000-000-0000 (Required.)

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6. Organization Name: (Required.)

Student Membership Information

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7. How many student memberships are you purchasing?
This form is intended for purchase of 5-30 student memberships. Please contact lsa@lsadc.org if you are registering more than 10 students or have questions about a small student group. (Required.)

You’ll enter payment info after the survey.
Please provide the requested information on behalf of all students included in the membership purchase. The number of students listed below should match the number indicated above. When finished, scroll to the bottom of the page to pay by credit card.

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8. Student 1: (Required.)

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9. Student 2: (Required.)

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10. Student 3: (Required.)

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11. Student 4: (Required.)

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12. Student 5: (Required.)

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13. Student 6:

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14. Student 7:

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15. Student 8:

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16. Student 9:

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17. Student 10:

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18. Student 11:

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19. Student 12:

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20. Student 13:

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21. Student 14:

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22. Student 15:

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23. Student 16:

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24. Student 17:

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25. Student 18:

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26. Student 19:

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27. Student 20:

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28. Student 21:

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29. Student 22:

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30. Student 23:

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31. Student 24:

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32. Student 25:

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33. Student 26:

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34. Student 27:

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35. Student 28:

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36. Student 29:

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37. Student 30:

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