Affiliate Membership Application

Are you interested in adding additional individuals to our mailing list (cost is $50 additional per person per year)? *
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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 is accepted, I agree to pay the CCIAOR Affiliate Membership Cost of $125.00 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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