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NNSEJC

New Membership Registration

New Member Registration

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MEMBERSHIP LEVEL *

Organizational ($150 per year) Individual ($100 per year) Retiree/Student ($25 per year)

PAYMENT TYPE *

Online Check

When you click submit at the end of this registration form, you will be able to pay your membership fee online. If you prefer to send in a check, the address will be provided on the next page. Thank you!

Organization (if Organizational level membership) *

Name (First, Last) *

First

Last

Email Address *

Phone Number *

Additional Email addresses (for organizational members only) *

Organizational members may list email addresses for up to 4 additional colleagues who would like to receive emails from CEJC.

Address *

Line 1

Line 2

City

State

Zip Code

Country

How did you hear about CEJC? *

Another CEJC member Colleague Webinar or other event (please list below) Website Have received CEJC communications in the past Other

Please provide details for question above: *

Are you interested in participating in a subcommittee? (Check all that are of interest.) *

Communication Policy Fundraising Membership

Do you have any of the following areas of expertise that would be helpful to CEJC? (Check all that apply and please provide details below.) *

Content expert in specific elder justice issue(s) Communications/Marketing Social Media Administration & Finance Advocacy on behalf of specific groups Policy Analysis Other

Additional Information: *

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