Apply for Membership – Drug Free Clubs of America

Name*

First Last

Email*

Student Name*

First Last

Student Email*

Select School*

Select Your Membership for A-Tech*

2 Year - $40

Select Your Membership for Adena*

1 Year - $10

Select Your Membership for ACE*

1 Year - $35

Select Your Membership for Ashland County - West Holmes CC*

1 Year - $20

Select Your Membership for Auburn Career Center*

1 Year - Free
2 Year - Free

Select Your Membership for Bioscience Center*

1 Year - $35
2 Year - $70

Select Your Membership for Chillicothe High School*

1 Year - Free

Select Your Membership for Circleville*

1 Year - $15

Select Your Membership for Conner*

1 Year - $35

Select Your Membership for Cooper*

1 Year - $35

Select Your Membership for East Central High School*

1 Year - $25

Select Your Membership for Beechwood High School*

1 Year - $35

Select Your Membership for Boone*

1 Year - $35

Select Your Membership for Bishop Brossart High School*

1 Year - $35
2 Year - $70
3 Year - $105
4 Year - $105

Select Your Membership for Campbell County High School*

1 Year - $35
2 Year - $70
3 Year - $105
4 Year - $105

Select Your Membership for Covington Catholic High School*

1 Year - $25
2 Year - $50
3 Year - $75

Select Your Membership for Dayton High School*

1 Year - $10

Select Your Membership for Dixie Heights High School*

1 Year - $35
2 Year - $70
3 Year - $105
4 Year - $105

Select Your Membership for Grant Career Center*

1 Year - $20
2 Year - $20

Select Your Membership for Hillsdale*

1 Year - $20

Select Your Membership for Holy Cross High School*

1 Year - $35
2 Year - $70
3 Year - $105
4 Year - $105

Select Your Membership for Huntington Local*

1 Year - $10

Select Your Membership for Notre Dame Academy High School*

1 Year - $25
2 Year - $50
3 Year - $75
4 Year - $75

Select Your Membership for Turkey Foot Middle School*

1 Year - $35
2 Year - $70
3 Year - $105

Select Your Membership for Bridgeport High School*

1 Year - Free

Select Your Membership for The Linsly School*

1 Year - $20
2 Year - $40
3 Year - $60
4 Year - $60

Select Your Membership for Paint Valley*

1 Year - $10

Select Your Membership for Parkersburg High School*

1 Year - $20

Select Your Membership for Parkersburg South*

1 Year - $20

Select Your Membership for Pickaway Ross Career & Technology Center*

1 Year - $10

Select Your Membership for Pickerington Central*

1 Year - $20

Select Your Membership for Pickerington North*

1 Year - $20

Select Your Membership for Ryle*

1 Year - $35

Select Your Membership for Sentinel*

1 Year - $15

Select Your Membership for Southeastern*

1 Year - $10

Select Your Membership for Triadelphia Middle School*

1 Year - $20
2 Year - $40
3 Year - $60

Select Your Membership for Unioto*

1 Year - $10

Select Your Membership for Vanguard*

1 Year - $15

Select Your Membership for Wayne County Schools Career Center*

1 Year - $10

Select Your Membership for Wheeling Central Catholic*

1 Year - $20
2 Year - $40
3 Year - $60
4 Year - $60

Select Your Membership for Wheeling Park High School*

1 Year - $20
2 Year - $40
3 Year - $60
4 Year - $60

Select Your Membership for Zane Trace*

1 Year - $10

Grade*

Student Birthdate*

Gender*

Homeroom Number (If Known)

Have you been a member before?*

Yes
No

Address*

Street Address Address Line 2 City State ZIP Code

Best Phone*

Parent Cell*

Student Cell*

Testing consent: I consent to the taking of specimens for drug screening as part of an examination in connection with enrollment into Drug Free Clubs of America (DFCA), and authorize the release of those results to DFCA and my parent or guardian.*

Yes

Photograph/video consent: I consent to the taking of, or the school’s release of, my (or my child’s) photograph, image, and/or likeness to be used by and for DFCA’s purposes.*

Yes

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Total

$0.00