CCGG Membership Application & Renewal Form

Online Application Instructions:
Applying for, or renewing your memebership online is a two-step process.  Step 1: You must complete the application information in Section 1.  You will then submit your application electronically by selecting "Submit Application Form". This action will open your email system.  Please select "send" from your email system to complete Step 1.  After you submit your application form, you will be returned to this page.  Step 2:  Proceed to Section 2, select your membership option, then select "Click here to Purchase".  You will be directed to our secure online payment system to complete your transaction.

Section 1:


Name:

Title:

Department Affiliation:  

Organization:            

Special Expertise or Interest:  

Mailing Address (business address only):

City, State, Zip:

Daytime Telephone:

Fax #:

Email Address:

Please check here if you do NOT want the information above to appear in the directory or website.
Would you like to receive our newsletter electronically?.

Section 2:

Secure on-line credit card transaction.
The information provided on this form will be used only by The California Council on Gerontology and
Geriatrics and its agents to process your membership application.  When you select the click here to purchase
button below you will be connected to VeriSign Payment Services to securely process your membership fees.
You will be returned to CCGG's website when the transaction is completed.


Individual Membership (General)
Your membership entitles you to a reduced annual conference registration fee.
$95.00 annually



Individual Membership (Student/Elder 65+)
Your membership entitles you to a reduced annual conference registration fee. 
$35.00 annually



Institutional Membership
Your membership entitles you to a reduced annual conference registration fee.  One to three members may
be listed per organization.
$225.00 annually






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