Membership Dues How many individual membership dues will you be paying today?*12345678910Are you a new CAAK member?*YesNoMember #1 Name* First Last Member ID # (if current CAAK Member) Member #1 Company/Organization* Title* Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Business Address(if different from mailing address) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Business Phone*Email* School and Date of Graduation(if a student) Member #1 Membership Type* Past Due Active Membership(After July 15th) : $60 – Must be currently employed by a municipality New Active Member: $50 – Must be currently employed by a municipality Past Due Associate Membership(After July 15th): $80 – Outside organizations involved in code enforcement New Associate Member:$70– Outside organizations involved in code enforcement Retired Membership: $50 – One-time payment for lifetime membership Student Membership: Free –Must be currently enrolled in an educational entity Member #2 Name* First Last Member ID # (if current CAAK Member) Member #2 Company/Organization* Member #2 Membership Type* Past Due Active Membership(After July 15th) : $60 – Must be currently employed by a municipality New Active Member: $50 – Must be currently employed by a municipality Past Due Associate Membership(After July 15th): $80 – Outside organizations involved in code enforcement New Associate Member:$70– Outside organizations involved in code enforcement Retired Membership: $50 – One-time payment for lifetime membership Student Membership: Free –Must be currently enrolled in an educational entity Member #3 Name* First Last Member ID # (if current CAAK Member) Member #3 Company/Organization* Member #3 Membership Type* Past Due Active Membership(After July 15th) : $60 – Must be currently employed by a municipality New Active Member: $50 – Must be currently employed by a municipality Past Due Associate Membership(After July 15th): $80 – Outside organizations involved in code enforcement New Associate Member:$70– Outside organizations involved in code enforcement Retired Membership: $50 – One-time payment for lifetime membership Student Membership: Free –Must be currently enrolled in an educational entity Member #4 Name* First Last Member ID # (if current CAAK Member) Member #4 Company/Organization* Member #4 Membership Type* Past Due Active Membership(After July 15th) : $60 – Must be currently employed by a municipality New Active Member: $50 – Must be currently employed by a municipality Past Due Associate Membership(After July 15th): $80 – Outside organizations involved in code enforcement New Associate Member:$70– Outside organizations involved in code enforcement Retired Membership: $50 – One-time payment for lifetime membership Student Membership: Free –Must be currently enrolled in an educational entity Member #5 Name* First Last Member ID # (if current CAAK Member) Member #5 Company/Organization* Member #5 Membership Type* Past Due Active Membership(After July 15th) : $60 – Must be currently employed by a municipality New Active Member: $50 – Must be currently employed by a municipality Past Due Associate Membership(After July 15th): $80 – Outside organizations involved in code enforcement New Associate Member:$70– Outside organizations involved in code enforcement Retired Membership: $50 – One-time payment for lifetime membership Student Membership: Free –Must be currently enrolled in an educational entity Member #6 Name* First Last Member ID # (if current CAAK Member) Member #6 Company/Organization* Member #6 Membership Type* Past Due Active Membership(After July 15th) : $60 – Must be currently employed by a municipality New Active Member: $50 – Must be currently employed by a municipality Past Due Associate Membership(After July 15th): $80 – Outside organizations involved in code enforcement New Associate Member:$70– Outside organizations involved in code enforcement Retired Membership: $50 – One-time payment for lifetime membership Student Membership: Free –Must be currently enrolled in an educational entity Member #7 Name* First Last Member ID # (if current CAAK Member) Member #7 Company/Organization* Member #7 Membership Type* Past Due Active Membership(After July 15th) : $60 – Must be currently employed by a municipality New Active Member: $50 – Must be currently employed by a municipality Past Due Associate Membership(After July 15th): $80 – Outside organizations involved in code enforcement New Associate Member:$70– Outside organizations involved in code enforcement Retired Membership: $50 – One-time payment for lifetime membership Student Membership: Free –Must be currently enrolled in an educational entity Member #8 Name* First Last Member ID # (if current CAAK Member) Member #8 Company/Organization* Member #8 Membership Type* Past Due Active Membership(After July 15th) : $60 – Must be currently employed by a municipality New Active Member: $50 – Must be currently employed by a municipality Past Due Associate Membership(After July 15th): $80 – Outside organizations involved in code enforcement New Associate Member:$70– Outside organizations involved in code enforcement Retired Membership: $50 – One-time payment for lifetime membership Student Membership: Free –Must be currently enrolled in an educational entity Member #9 Name* First Last Member ID # (if current CAAK Member) Member #9 Company/Organization* Member #9 Membership Type* Past Due Active Membership(After July 15th) : $60 – Must be currently employed by a municipality New Active Member: $50 – Must be currently employed by a municipality Past Due Associate Membership(After July 15th): $80 – Outside organizations involved in code enforcement New Associate Member:$70– Outside organizations involved in code enforcement Retired Membership: $50 – One-time payment for lifetime membership Student Membership: Free –Must be currently enrolled in an educational entity Member #10 Name* First Last Member ID # (if current CAAK Member) Member #10 Company/Organization* Member #10 Membership Type* Past Due Active Membership(After July 15th) : $60 – Must be currently employed by a municipality New Active Member: $50 – Must be currently employed by a municipality Past Due Associate Membership(After July 15th): $80 – Outside organizations involved in code enforcement New Associate Member:$70– Outside organizations involved in code enforcement Retired Membership: $50 – One-time payment for lifetime membership Student Membership: Free –Must be currently enrolled in an educational entity Total Due: $0.00 Payment InfoPayor Name* First Last Payor Email Address* Payor Company/Organization* Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Name on Card
