CCA-South: Meeting Registration & Membership Form for November 5, 2016

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CCA-South: Membership Form & Meeting Registration for November 5, 2016

MEMBERSHIP INFORMATION SECTION

Please complete this section to update your membership information for the 2016-2017 academic year.

Name *

School Affiliation (if any)

Email Address *

Mailing Address

The address above is my:

home address

school address

Clear selection

Phone Number

Membership Type *

Regular ($20)

Sustaining ($25)

Student ($8)

Retired ($8)

Purchase Life Membership ($150)

First-Year Teacher (free)

Already a Lifetime Member (no charge)

I do not wish to be a member of CCA-South.

CCA-North Affiliation *

Affiliation with CCA-North includes newsletter.

Yes, I would like to be an affiliated member of CCA-North ($5 fee).

No, thank you.

MEETING REGISTRATION SECTION

Please complete this section to register for the Fall meeting OR to indicate that you will not be attending.

Registration Type *

Member ($30 registration fee)

First-time Attendee ($30 registration fee)

Student ($20 registration fee)

Non-Member ($50 registration fee)

I do not wish to attend the meeting; I am renewing my membership only.

Submit

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