Membership Dues How many individual membership dues will you be paying today?*12345678910Are you a new CAAK member?*YesNoWhat is Your DHBC License Number, if you do not have a DHBC Plumbing, HVAC, Electric, or Building license number, enter NA*If you enter NA, then your CEU hours will not be uploaded to the licensing portal for your DHBC license renewal and you won't be able to renew or claim CAAK CEU's for your license number.Member #1 Name* First Last Member ID # (if current CAAK Member) Member #1 Company/Organization*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* New Active Member: $50 – Must be currently employed by a municipality Past Due Active Membership(After July 15th) : $60 – 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) What is Your DHBC License Number, if you do not have a DHBC Plumbing, HVAC, Electric, or Building license number, enter NA*If you enter NA, then your CEU hours will not be uploaded to the licensing portal for your DHBC license renewal and you won't be able to renew or claim CAAK CEU's for your license number.Member #2 Company/Organization*Member #2 Membership Type* New Active Member: $50 – Must be currently employed by a municipality Past Due Active Membership(After July 15th) : $60 – 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) What is Your DHBC License Number, if you do not have a DHBC Plumbing, HVAC, Electric, or Building license number, enter NA*If you enter NA, then your CEU hours will not be uploaded to the licensing portal for your DHBC license renewal and you won't be able to renew or claim CAAK CEU's for your license number.Member #3 Company/Organization*Member #3 Membership Type* New Active Member: $50 – Must be currently employed by a municipality Past Due Active Membership(After July 15th) : $60 – 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) What is Your DHBC License Number, if you do not have a DHBC Plumbing, HVAC, Electric, or Building license number, enter NA*If you enter NA, then your CEU hours will not be uploaded to the licensing portal for your DHBC license renewal and you won't be able to renew or claim CAAK CEU's for your license number.Member #4 Company/Organization*Member #4 Membership Type* New Active Member: $50 – Must be currently employed by a municipality Past Due Active Membership(After July 15th) : $60 – 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) What is Your DHBC License Number, if you do not have a DHBC Plumbing, HVAC, Electric, or Building license number, enter NA*If you enter NA, then your CEU hours will not be uploaded to the licensing portal for your DHBC license renewal and you won't be able to renew or claim CAAK CEU's for your license number.Member #5 Company/Organization*Member #5 Membership Type* New Active Member: $50 – Must be currently employed by a municipality Past Due Active Membership(After July 15th) : $60 – 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) What is Your DHBC License Number, if you do not have a DHBC Plumbing, HVAC, Electric, or Building license number, enter NA*If you enter NA, then your CEU hours will not be uploaded to the licensing portal for your DHBC license renewal and you won't be able to renew or claim CAAK CEU's for your license number.Member #6 Company/Organization*Member #6 Membership Type* New Active Member: $50 – Must be currently employed by a municipality Past Due Active Membership(After July 15th) : $60 – 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) What is Your DHBC License Number, if you do not have a DHBC Plumbing, HVAC, Electric, or Building license number, enter NA*If you enter NA, then your CEU hours will not be uploaded to the licensing portal for your DHBC license renewal and you won't be able to renew or claim CAAK CEU's for your license number.Member #7 Company/Organization*Member #7 Membership Type* New Active Member: $50 – Must be currently employed by a municipality Past Due Active Membership(After July 15th) : $60 – 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) What is Your DHBC License Number, if you do not have a DHBC Plumbing, HVAC, Electric, or Building license number, enter NA*If you enter NA, then your CEU hours will not be uploaded to the licensing portal for your DHBC license renewal and you won't be able to renew or claim CAAK CEU's for your license number.Member #8 Company/Organization*Member #8 Membership Type* New Active Member: $50 – Must be currently employed by a municipality Past Due Active Membership(After July 15th) : $60 – 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) What is Your DHBC License Number, if you do not have a DHBC Plumbing, HVAC, Electric, or Building license number, enter NA*If you enter NA, then your CEU hours will not be uploaded to the licensing portal for your DHBC license renewal and you won't be able to renew or claim CAAK CEU's for your license number.Member #9 Company/Organization*Member #9 Membership Type* New Active Member: $50 – Must be currently employed by a municipality Past Due Active Membership(After July 15th) : $60 – 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) What is Your DHBC License Number, if you do not have a DHBC Plumbing, HVAC, Electric, or Building license number, enter NA*If you enter NA, then your CEU hours will not be uploaded to the licensing portal for your DHBC license renewal and you won't be able to renew or claim CAAK CEU's for your license number.Member #10 Company/Organization*Member #10 Membership Type* New Active Member: $50 – Must be currently employed by a municipality Past Due Active Membership(After July 15th) : $60 – 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 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Expiration Date Security Code Name on Card
