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Department Signup

Department Account

Department Name

Billing Address Information

Street Address
City
State
ZIP
Phone Number
Fax Number
Accounts Payable Person
Accounts Payable Phone #
Accounts Payable Email Address

Will you pay your members' membership fees?

Choose a Membership Program

2-Year Unlimited [1-4 members: $100.00, 5-25 members: $90.00, 26-49 members: $80.00, 50+ members: $70.00]
1-Year Unlimited [1-4 members: $60.00, 5-25 members: $50.00, 26-49 members: $45.00, 50+ members: $40.00]
Per hour program: 5 hours [1-4 members: $25.00, 5-25 members: $22.00, 26-49 members: $20.00, 50+ members: $18.00]
Per hour program: 10 hours [1-4 members: $50.00, 5-25 members: $44.00, 26-49 members: $40.00, 50+ members: $36.00]
Per hour program: 15 hours [1-4 members: $75.00, 5-25 members: $66.00, 26-49 members: $60.00, 50+ members: $54.00]

Department Administrator

First Name (Capitalize First Letter)
Last Name (Capitalize First Letter)
Login (username), case insensitive
Password, case sensitive
Confirm Password
Email Address