PRINTABLE MEMBERSHIP APPLICATION FORM
Print this page, then mail the completed form along with your dues payment.  
Please mail your check payable as follows:  
   

CCGO c/o The Arnold Law Practice
3620 Happy Valley Road, Suite 101
Lafayette, CA 94549
 
New member dues are prorated quarterly starting April 1. Accordingly, if you join CCGO after March 31st, your dues for the following calendar year will be reduced on a quarterly basis.
 
Name of Organization / Business:
 
Name of Contact:
 
Type of Organization or Business: (educational, consulting, petroleum, etc.)
 
Mailing Address:
 
City:
 
State, Zip:
 
Email:
 
Phone:
 
Fax:
 
Web Site Address:
 
What / Who Prompted You to Join?
 
Membership Dues:
(Please Refer to Chart Below)
 
Voluntary Contribution:
($25 recommended)
 
Total Amount:
(Sum of Dues and Contribution)
 
 
MEMBERSHIP DUES BREAKDOWN
 
# of Members or Employees
Dues
Fewer than 5
$25
6-10
$50
11-50
$100
51-100
$150
101-150
$275
151-200
$350
201-250
$500
More than 250
$600