Membership Application - Web Form

Please fill in all information
NOTE:  Payment instructions will follow after submitting your online application.

Name:
Street Address, Apt #:
City, State, Zip: ,    
Telephone:
E-mail Address:
Chapter No. (if known):
New or Renewal: New     Renewal
Payment Options: Submit through mail     Submit through PayPal
*Payment instructions will follow after submitting your online application.
Membership Fee Amount: Use the following to calculate your dues:
ANNUAL DUES:  July 1st through June 30th
If you are joining in:
  • July through September - pay the full year
  • October through December - pay 3/4 year
  • January through March - pay 1/2 year
  • April through June - pay 1/4 year
  Full year 3/4 year 1/2 year 1/4 year
Regular Dues: $25.00 $18.75 $12.50 $6.25
Student/Low Income Dues: $10.00 $7.50 $5.00 $2.50
Family (2 people) Dues: $40.00 $30.00 $20.00 $10.00
Additional Person Dues: $4.00 $3.00 $2.00 $1.00
Non-Member/New World
Annual Subscription only:		 $20.00 $15.00 $10.00 $5.00
Lifetime Membership: $200.00
Total Membership Fees $   *Please jot down amount to be submitted!
 Please put me on the CDR Members Exchange via Yahoo Groups (must supply e-mail address)
Questions/Comments: