Affiliate Membership Application

Thank you for your interest in the CCIAOR Affiliate Program
Annual 2024 Affiliate Membership Dues are pro-rated quarterly. Current rate is $187.50.  (January - December: $250.00)
Are you interested in adding additional individuals to our mailing list? The cost is $50 additional per person per year. If yes, your card will be charged an additional $50 per secondary affiliate member you would like to add. *
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How Did You Hear About the Affiliate Program? *
Event & Program Sponsorships *

Agreement & Payment

I understand that completing this application does not guarantee my Affiliate Membership and that my application must be reviewed and approved by Association staff. 
If my membership as a new member is accepted, I agree to pay the 2024 CCIAOR Affiliate Membership current pro-rated cost of $187.50; plus $50 for any additional individuals listed on my application above. I understand that my annual membership dues are non-refundable. 
I agree that my act of paying dues shall evidence my initial and continuing commitment to abide by the Association Bylaws and Rules and Regulations, from time to time amended, and available on the Association website. 
Signature *
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