MEMBERSHIP APPLICATION/RENEWAL FORM

Primary Institutional Member

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*First Name:	Mr. Mrs. Ms. Dr.
*Last Name:
Title:
*Institution/School District:
*Department:
*Institution Address:
*City/State/Zip:			AK AL AR AZ CA CO CT DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
*County:
*Telephone:
Fax:
*Email:
District Web Site:
* = required

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Membership year: July 1 to June 30
Please make checks payable to CAEE

Institutional Membership:
California post-secondary institutions, schools or school districts. Fee: $50.00 per year

Individual Membership (fees paid by individual, not an organization):
Fee: $25.00/yr

Associate Membership:
Organizations in California that support the mission and objectives of CAEE. Fee: $50/yr

Return payment along with a copy of your registration confirmation to:
Vicki Johnson
California State University, Dominguez Hills
Student Development Office
1000 E. Victoria
Carson, CA 90747

Questions:
Email membership@caeelink.org or call 310-243-3625