Membership Application

Instructions

Please complete the membership application for your program. Membership runs July 1 - June 30, and dues are $500 per year. Dues cover everyone in the academic program at no extra cost: faculty, clinic directors, and staff.

When entering the contact information, please use the program director/department chair name, email, and phone number.

Applications are accepted year-round and dues are not pro-rated.

Thank you for your interest in joining CAPCSD.

Select An Option

Member $500 Annually

Enter Contact Information

Prefix (i.e. Mr. Mrs. Dr.)

First Name

Last Name

Suffix (i.e Jr. Sr. III)

Designations

E-mail

Family NameOrganization Name

Please select a valid membership option and fee item if exist