Renewal
New Member

AFCC DUES:
Please Select Type of Membership AFCC :Individual - $150.00 AFCC :Institutional- $360.00 AFCC :Student- $60.00 1 2 3 4 5

Chapters

ARIZONA CHAPTER DUES:
Please Select Type of Membership Arizona :Individual-$25.00 Arizona :Institutional - $40.00 Arizona :Student- $10.00 1 2 3 4 5

CALIFORNIA CHAPTER DUES:
Please Select Type of Membership California :Individual-$50.00 California :Institutional - $75.00 California :Student - $10.00 1 2 3 4

COLORADO CHAPTER DUES:
Please Select Type of Membership Colorado :Individual-$40.00 Colorado :Student- $10.00 1 2

FLORIDA CHAPTER DUES:
Please Select Type of Membership Florida :Individual-$30.00 Florida :Student- $5.00 Florida :Institutional- $55.00 1 2 3 4

LOUISIANA CHAPTER DUES:
Please Select Type of Membership Louisiana :Individual-$50.00 1 2 3

MASSACHUSETTS CHAPTER DUES:
Please Select Type of Membership Massachusetts :Individual-$30.00 Massachusetts :Institutional-$50.00 Massachusetts :Student-$0.00 1 2

MINNESOTA CHAPTER DUES:
Please Select Type of Membership Minnesota :Individual-$25.00 Minnesota :Student-$0.00 1 2

MISSOURI CHAPTER DUES:
Please Select Type of Membership Missouri :Individual-$30.00 Missouri :Institutional - $55.00 Missouri :Student - $15.00 1 2

NEW JERSEY CHAPTER DUES:
Please Select Type of Membership New Jersey :Individual-$30.00 1 2 3

NEW YORK CHAPTER DUES:
Please Select Type of Membership New York :Individual-$45.00 New York :Institutional-$100.00 New York :Student-$0.00 1 2 3 4 5

ONTARIO CHAPTER DUES:
Please Select Type of Membership Ontario :Individual-(CDN)* $45.00 Ontario :Student $0.00 1 2 3

TEXAS CHAPTER DUES:
Please Select Type of Membership Texas :Individual-$20.00 Texas :Institutional - $40.00 Texas :Student-$5.00 1 2 3

*Please send checks and money orders in U.S. dollars, except a separate $45 check for Ontario Chapter dues only, which must be in Canadian dollars. Credit cards payments from outside the U.S. will be processed at the exchange rate on the date of transaction.

GRAND TOTAL:

Professional Designation

Please indicate your primary professional designation on the first line below, and up to two additional designations on the following lines. Please select from the list below.

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2.
3.

Academic, Court Administrator, Court Commissioner, Custody Evaluator, Financial Planner, Judge, Lawyer, Mediator, Mental Health Professional, Parenting Coordinator, Parent Educator, Researcher, Other (please specifiy)

Please check this box if you do not wish to have your contact information and professional designation included on the professional referral database available to the public.

How Did You Hear About AFCC?

You may print out this form and fax it to AFCC at (608) 664-3751 or click on "Apply" below to join electronically.

If you do not receive confirmation of your application membership within one week please contact the AFCC office at afcc@afccnet.org