Individual Membership Form

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Include a submember in your membership registration

Members who wish to make a financial contribution to CCAE that is beyond the Regular or Associate Membership fee may opt to add a Diamond Member upgrade to their current membership level. NOT available for Friend of CCAE or Student Memberships.

First Name *

Last Name *

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Phone 1 *

Email *

Alternate Email

CCAE Section *

Bay

Central

LA Metro

Northern

South Coast

Southern

N/A

CCAE Chapter *

School/Organization *

Referred by

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CCAE Portal - If you haven't set up your CCAE Portal, you can do that now to manage account information, or skip this step and set up your portal later. If you are a renewing member, it is best to log in to the CCAE Portal to complete your renewal.

Password

Retype Password

Payroll Deduction - Will you be paying your CCAE membership fee through payroll deduction? *

Yes

If you select "Yes," choose Pay Later at checkout.

Volunteer - Are you interested in volunteering with CCAE?

Yes, please inform me of CCAE volunteer opportunities.

No, not at this time.

COABE - As a member of CCAE, you automatically gain membership with COABE, including receiving member emails. Do you prefer to opt out of COABE emails?

Yes

Diamond - Will you be purchasing the Diamond Add-On today, an additional $200 contribution to adult education? *

Yes

If you select "Yes," complete Diamond registration on the next page. Otherwise, skip to payment.

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Include a submember

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Choose Existing Contact(s)

Membership Level *

Enable automatic annual renewal of your CCAE membership. Only select this option if paying at checkout today. (Not available for offline payments or Payroll Deduction.)

First Name *

Last Name *

Address Line 1

Address Line 2

City

State/Province

Zip/Postal Code

Country

Add {{subMemberDisplayName}}

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$ Add Diamond Membership

One-Time Fee

Monthly gifts go further — cancel or pause anytime.

Other Amount

{{donationOtherAmountLabel}} *

USD

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{{orderSummary.membershipsTotal==0?'Free':formatAmount(orderSummary.membershipsTotal)}}

Membership auto-renews monthly for {{ formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipInstallment.cost) }} until {{ orderSummary.membershipOrderItem.membershipInstallment.endDate }}

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Membership auto-renews on {{orderSummary.membershipOrderItem.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(orderSummary.membershipOrderItem.membershipAutoRenew.cost)}}

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Membership auto-renews on {{sm.membershipAutoRenew.renewDate}} for {{formatAutoRenewAmount(sm.membershipAutoRenew.cost)}}

Frequency selected: {{recurringUnitText}}. Next add-on payment processes on {{orderSummary.recurringDonationNextDate}} for {{formatAmount(orderSummary.donationAmount)}}

Discount Code

Code:

-{{formatAmount(orderSummary.codeDiscount)}}

Order summary

Subtotal {{formatAmount(orderSummary.subtotal)}}

Discounts -{{formatAmount(orderSummary.discounts)}}

Total {{formatAmount(orderSummary.total)}}

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Card

Pay Later

or enter your card details below

Cardholder First Name *

Cardholder Last Name *

Cardholder Email

Card *

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Billing address is the same as mailing address

Address Line 1

Address Line 2

City

State/Province

Zip *

Country

Pay directly from your bank account. This option is secure and avoids credit card processing fees.

I will pay offline through payroll deduction or check.

PAYROLL DEDUCTION
Elect to automate payment installments deducted directly from your payroll each pay period. Contact your payroll department or membership chair to complete this process.

CHECK*
Please mail your payment to:
California Council for Adult Education
6755 Mira Mesa Blvd.
Suite 123121
San Diego, CA 92121

*Be sure to add Name of Member in the Memo Field of your check.

Amount:

{{formatAmount(totalAmount)}} USD

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CCAE Individual Membership Form

Membership level allows for a maximum of {{term.subMemberAllowed}} submembers.

	Contact Name	Membership Level
	{{item.contactName}}	{{item.membershipLevel==null?'-':item.membershipLevel}} {{item.startDate}} - {{item.endDate}}
No contacts.