Apply for CAPPS 2019 Membership Date* School Name*Membership Status* New School Member Renew School Membership Please select "New" if you have not been a CAPPS Member in more than two years.Your Name* First Last Your Title*Your Email* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country School Website Address *MUST include the entire website address, including http:// Example: http://www.MyWebsite.comPhone*FaxSchool DescriptionPlease state how you would like your listing to read. (You may type "no changes" if this is a renewal.)Multiple LocationsIf your School offers mulitple campus locations, please enter total number here. We will use your website to pull up the addresses. Additional Contact #1 - Name First Last Additional Contact #1 - TitleAdditional Contact #1 - Email Additional Contact #2 - Name First Last Additional Contact #2 - TitleAdditional Contact #2 - Email Additional Contact #3 - Name First Last Additional Contact #3 - TitleAdditional Contact #3 - Email Please select from dropdown menu. Choose the dollar value of your Institution's Gross Annual Tuition Revenue (California).*School Dues TiersPLEASE SELECTExempt InstitutionsReligious Exempt Institutions$0 - $149,999$150,000 - $299,999$300,000 - $499,999$500,000 - $999,999$1,000,000 - $ 1,999,999$2,000,000 - $2,999,999$3,000,000 - $3,999,999$4,000,000 - $4,999,999$5,000,000 - $5,999,999$6,000,000 - $6,999,999$7,000,000 - $7,999,999$8,000,000 - $8,999,999$9,000,000 - $9,999,999$10,000,000 - $19,999,999$20,000,000 - $24,999,999$25,000,000 - $29,999,999$30,000,000 - $34,999,999$35,000,000 - $39,999,999$40,000,000 - $44,999,999$45,000,000 - $49,999,99950,000,000 - $54,999,999$55,000,000 - $59,999,999$60,000,000 - $69,999,999$70,000,000 - $79,999,999$80,000,000 & AboveTotal Due $0.00 *Please Note: Eighteen percent (18%) of membership dues are used for lobbying purposes and are not tax deductible.Payment Method*Invoice and payment option can both be selected. Auto renewal invoice will be sent in time for Early renewal discounts (around November next year), if selected. Pay By Credit Card Request Invoice Check in the Mail Auto Renewal Invoice for future Annual Terms Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Discount Code
