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

Be sure to select the region where your school is located, as members can only attend regional meetings in their school's region.

Member Information

Name/Title: *

School: *

Address: *

Telephone: *

Fax:

Email Address: *

ConnCASE Region # (ADD # NOT STATE): *

Mentorship Program

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.

Credit Card Payment Information

Amount: *$0.00