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EDUCATOR & STUDENT Membership Application
Annual Dues: $40.00 for Educators; $10.00 for Students
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 We accept MasterCard, VISA or American Express
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____________________________________________________________________________
PLEASE COMPLETE THIS FORM TO APPLY FOR
CLCID EDUCATOR OR STUDENT MEMBERSHIP
Your information is being transmitted over a Secure Server
which encrypts the information for your safety. CLCID will keep your information confidential and is for our use only. .
Payment Options:
If you do not wish to provide your credit card online, you may pay by:
1. Telephone: Fill in the online form and call us at (800) 79-CLCID with your credit card
information.
2. Fax: Print this online form, fill it in and Fax to 909-899-7129
3. Mail: Print this online form, fill it in and mail it with your check to
CLCID, 13971 Annadale Lane, Rancho Cucamonga, CA 91739
If you have any questions regarding Educator or Student membership requirements or regarding the use of this form, please call CLCID at
(800) 79-CLCID or e-mail us.
Fields with *are required. Use your "TAB" key to jump to each field.
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Are you an Interior Design Educator or a Student? (check one only)
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Educator
Full-time student
Part-time student
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*Your name
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Mr.
Ms. |
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Campus Name
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Department
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*Address
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*City
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*State
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*Zip Code
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Phone - (include Area Code)
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FAX - (include Area Code)
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*Your E- mail address (required)
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School's Web site address (if known)
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Are you a member of an interior design association? If so, please check all that apply
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ASID |
IDS |
IFDA |
IIDA |
NKBA |
Other |
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If you checked "other", please type association name(s) in this box:
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METHOD OF PAYMENT
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Type of Credit Card
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Card number (please double check)
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Expiration date (MMYY)
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Name on the Card
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Cardholder's address (fill out completely including zip code)
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Amount Authorized: ($40.00 for Educators; $10.00 for Students)
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Comments or questions? Fill in below
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YES, add my name to receive CLCID's Direct-Link email newsletter
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