CCCOER/Committees/membership/proposed application

Please consider the Membership application form provided below
When accompanied by an explanatory membership brochure/web page, is this application sufficient from a new member's point of view?

When received by the Membership Committee, does this application give enough information to make a recommendation to accept or deny membership?

Please use the discussion tab above to post comments.

Membership Application
"The mission of the Community College Consortium for Open Educational Resources (CCCOER) is to promote the creation, publication, dissemination, and use of high quality, open licensed learning and teaching materials (including but not limited to textbooks, courseware, lessons, question banks and other educational resources) primarily intended for use by learners, educators and institutions engaged in the first two years of post-secondary education."

The applicant below subscribes to the Mission of CCCOER, agrees to support the purposes of CCCOER and to be governed by the CCCOER Bylaws in related matters.

Applicant Name: ________________________________________________

Applicant is ____ an individual or ____ an institution/organization

If institution/organization, please characterize ____________________________

(for example: 2-yr college, state association, independent nonprofit organization, int’l NGO, etc.)

Primary Contact Last Name ________________ First Name ____________

Primary Contact Preferred Email Address ___________________________

Primary Contact Alternate Email Address ___________________________

Primary Contact Telephone _______________________________________

Primary Contact Postal Address _________________________________________________________ _________________________________________________________

_________________________________________________________

Secondary Contact Last Name ________________ First Name ____________

Secondary Contact Preferred Email Address ___________________________

Secondary Contact Alternate Email Address ___________________________

Secondary Contact Telephone _______________________________________

Secondary Contact Postal Address _________________________________________________________ _________________________________________________________

_________________________________________________________

Membership Level                  Annual dues     3- year dues     Circle Payment Method

Copper                                  $90                  $189                PP MC V C O_________________

Silver                                   $250                   $525               PP MC V C O_________________

Gold                                    $500                 $1,050              PP MC V C O_________________

Platinum                           $5,000                 $10, 500            PP MC V C O_________________

Payment methods are: PP Pay Pal, MC Master Card, V Visa Card, C check, O Other (specify)

(To substitute in-kind donation for any portion of cash membership dues, please contact Treasurer with written proposal.)

Administrative Authorization to join CCCOER by (

(printed name) _________________________________(title) __________________________

Signature _________________________________________ date _______________ /