Affiliate Membership Application

Please complete the fields located below. For additional information, please contact [email protected].

Affiliate Membership Application

URL

This field is for validation purposes and should be left unchanged.

General Organization Information

Organization(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Website(Required)

President or CEO

Full Name(Required)

Title(Required)

Email(Required)

Phone(Required)

Person Completing This Form

Full Name(Required)

Title(Required)

Email(Required)

Phone(Required)

Which CIC programs and services are of particular interest to your institution?

Additional Information

Link to Annual Report