CASP Membership

MEMBERSHIP APPLICATION

May 1, 2008 - June 30, 2009

Note: To pay by check or Payroll Deduction you will need to download the application and mail it in.

This application is a:

Renewal or New Member (Have not been a member in the last 3 years)

Payroll Deduction

As of 1/01/07 - CASP will no longer accept new payroll deduction requests

Pursuant to Education Code 45060, I authorize the above-named school district to withhold $14.20 per month from my salary for 10 months of each year beginning with the next regularly scheduled payroll for payment of CASP dues.

Note: To pay by payroll deduction you need to download the membership form and mail it to our office.

Notice: Please note that your membership year begins on July 1 and ends on June 30 the following year, regardless of when you join during the membership year. We do not offer a pro-rated rate for memberships that begin after July 1. No credit card refunds for memberships will be made after 7 days from the submission date of this application.

Pursuant to the Omnibus Budget Reconciliation Act of 1993 and provisions contained in the lobbying tax law, CASP is required to inform members that 20% of your dues payment is non-deductible as an "ordinary and necessary" business expense. Contributions or gifts to CASP are not tax deductible as charitable contributions. However, they may be tax deductible under other provisions of the Internal Revenue Code.

MEMBERSHIP CATEGORIES
(Please Check One)

Regular Member - $142.00
(Regular Members are persons who (1) are credentialed school psychologists employed in the State of California, OR (2) are Licensed Educational Psychologists.)

Student Member ** - $50.00
(Student Members are persons who are enrolled in a full-time training program leading to a credential in school psychology. Applicants in this category must present documentation of university or college enrollment, or secure the signature of an advisor.)
** Your application will not be processed until documentation of enrollment in a college or university is submitted.

1st Year School Psychologist - $50.00
Members in this category are persons who are renewing CASP members that have graduated during the 2004-2005 membership year. Applicants must submit an advisor / supervisor signature.

Retired Member - $60.00
(Retired Members are persons who are retired for active employment in the schools and are not employed in any capacity that would qualify for membership in any other category.)

Associate Member - $142.00
(Please choose one)
Credentialed school psychologist employed in a state other than California.
Credentialed school psychologist who is on a leave of absence due to personal or professional reasons, such as persuing an advanced degree.
A member of a college or university faculty but NOT a credentialed school psychologist.
A member of an allied profession, interested in the activities of CASP.
Have a school psychology credential, but have functioned as a school administrator for the past five years

NOTE: ADDRESS MUST MATCH THAT OF YOUR CREDIT CARD

PERSONAL INFORMATION
(Please complete as applicable)
Required Fields

*First Name:

*Last Name: .

*Home Address:

*City:

*State:

*Zip Code:

*E-Mail:

Employer:

County Where You Work:

Home Phone:

*Work Phone:

Alt. Phone:

(Optional)Voice Mail:

(Optional)Fax Number:

Region Number:

Job Title:

PAYMENT OPTIONS
(Please Check One)

I am interested in donating to the annual "CLD" Cultural and Linguistic Diversity Scholarship

I am interested in donating to the "PAC" CASP Political Action Committee

I am interested in donating to the CSP Foundation Mini Grant Fund.

Payment in Full

Subtotal $
CLD Scholarship Donation: $
CASP PAC Donation: $
CSP Mini Grant Donation: $

You are authorized to charge my Visa / Mastercard for the payment of the dues in the amount of: $.

Card Number:
Card Type:
Expiration Date: Month Year (Range: 1997~2020)

By typing in "AGREE" in this box you authorize the signature for this card.
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Support the California School Psychology Foundation (optional)

These two hassle-free programs provide new ways for the California School Psychology Foundation to raise funds through everyday purchases at eScrip merchants – such as Macy’s, OfficeMax and Big 5 Sporting Goods – and at Albertson’s Supermarkets.

You shop. The CSP Foundation receives money, based on your purchases, for the Mini-Grant Program. You apply for funding through the program to help your students. Everybody wins!

It’s easy to participate.

Please add my:

Albertson's Preferred Savings Card Number:

Phone Linked to Albertson's Card (Usually Your Home Phone):

Macy's Credit Card Number:

OfficeMax Credit Card Number:

Visa or Mastercard Number:

Exp. Date (mm/yy):

American Express Card Number:

Exp. Date (mm/yy):

For any questions or problems with this page please contact
webmaster@casponline.org

PERSONAL INFORMATION (Please complete as applicable) Required Fields
*First Name:
*Last Name:	.
*Home Address:
*City:
*State:
*Zip Code:
*E-Mail:
Employer:
County Where You Work:
Home Phone:
*Work Phone:
Alt. Phone:
(Optional)Voice Mail:
(Optional)Fax Number:
Region Number:
Job Title: