Pursuant to the Federal Privacy Act (Public Law 93-579) and the Information Practices Act (IPA) of 1977 (Civil Code Sections 1798, et seq.), notice is hereby given for the request of personal information. Failure to provide all or any part of the requested information may delay processing of this form or result in an incomplete record. No disclosure of personal information will be made unless permissible under Article 6, Section 1798.24 of the IPA of 1977. Each individual for whom personal information is collected has the right to inspect that information in any record maintained by CCGIA. Inquiries may be directed to the CCIGA Board of Directors at the address listed above.

INSTRUCTIONS
Please complete ALL sections of the application. Failure to complete any section of this application will result in a delay in processing the application.

Read this application in its entirety. By signing the application you are signifying that you read the entire application and agree to all terms therein.

Type or legibly print (in ink) all required information. The fastest way to be considered for membership is to fill this application out online, and return it via email to membership@ccgia.org.

** All membership applications will be reviewed by the CCGIA Board of Directors. CCGIA reserves the right to approve or reject any application, for any reason they deem necessary. Furthermore, CCGIA reserves the right to cancel any membership at any time, for any reason, with or without explanation to the involved parties**