OCTAA

On-Line Membership Application

	MEMBER INFORMATION
Select a Membership Type	Individual Membership ($50.00) (1) year membership for one adult, aged 18 years or older. Family Membership ($75.00) (1) year membership for one family: one or two parents and their children (under 18 years of age). Each spouse/parent who is a member through Family Membership shall be entitled to one vote. Student Membership ($25.00) (1) year membership for one full- or part-time student, 18 years of age or older, attending school within the state of California.
Select a Payment System	Offline Payment - Offline Payment (check/money order) PayPal - secure credit card payment (a PayPal account is not required)
Your Name Your First & Last name
Your E-Mail Address A confirmation email will be sent to you at this address
Choose a Login Name (User ID) It must be 4 or more characters in length and may only contain small letters, numbers, and the underscore '_'	check for uniqueness
Choose a Password Must be 4 or more characters
Confirm your password Enter password again

Street
City
State
ZIP
Country
Phone (daytime)
Phone (evening)
Profession
Company/Organization/School
Spouse Your spouse's name (first and last), if you are applying for Family membership.
Children Names and birth years of your children.
Volunteer? I would like to volunteer with OCTAA, please contact me!	Yes No
Contact How would you prefer to be contacted by OCTAA?	E-Mail US Mail Do not contact me
Additional Info Areas of Interest / Comments / Suggestions