Tuesday, March 28, 2017

Membership Application

Please fill out the form below completely. After filling out the form you will be automatically directed to the PayPal payment page. Your membership application is not complete until your PayPal payment has been received.

If you wish to pay using a check or money order, please use the mail in membership and subscription form located here.

Your Name (required):
Your Email (required):
Organization (optional):
Street (optional):
City (optional):
State/Province (optional):
Zip/Postal Code (optional):
Primary Phone (required):
Secondary Phone (optional):
yesno Would you like to receive an invitation to join the EEWC-CFT Google Group (this is a platform for group discussion emails)? Select 'no' if you are already a member.
emailregular mail Please indicate if you would like our primary means of contacting you to be email or regular mail.
yesno Have you been an EEWC-CFT member in the past?
How did you learn about EEWC-CFT?
If you selected "Other" above, please give us more information:

Any additional information you'd like to provide?

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If you encounter any problems using the online membership application form, please contact the webmaster for assistance.