2026 - 2027 Membership Application - Credit Card Only

To apply for ConnCASE membership, please complete the form below.

(* Denotes Required Fields)

Membership Selection

Membership Type: *

New Renewal

Membership Category: *

Active Membership (+$250.00) Associate Membership (+$150.00) Retired Membership (+$60.00)

Note: Regional dues are INCLUDED in your ConnCASE membership.

Name/Title: *

School: *

Address: *

Telephone: *

Fax:

Email Address: *

ConnCASE Region # (ADD # NOT STATE): *

Are you interested in the Mentoring Program?: *

Yes, I am interested in being a Mentor Yes, I am interested in being a Mentee No, not at this time

Mentor Requirements: In your current position for a minimum of 3–5 years and MUST be at the Director level.

Mentee Requirements: In your current position for a minimum of 2 years or less and MUST be at the Director level.

Amount: *$0.00