2023 Agricult
ural Cooperative
Directors and Executives Conference
Registration Form
Your Contact Information
First Name
Last Name
Email Address
Phone
Add me to your email list
Your Business/Organization Information
Business Name
Business Email Address
Business Phone
Business Website
Your Role in Organization
Role in the organization
Director
Management
Other
If other, please specify
Registration
I am a current member (thank you for your membership)
Yes - Individual
Yes - Organizational
No
I would like to renew my membership (thank you for your renewal)
Yes
No
I would like to become a member (members get $50 discount per person per session)
Yes - for my co-op or organization
Yes - as an individual
No
Please choose your membership level
Annual Co-op/Org Revenue $1 billion & above: $750 / yr
Annual Co-op/Org Revenue $100 million - $999 million: $500 / yr
Annual Co-op/Org Revenue $3 million - $99 million: $350 / yr
Annual Co-op/Org Revenue $1 million - $2.9 million: $250 / yr
Annual Co-op/Org Revenue $700 thousand - $999 thousand: $200 / yr
Annual Co-op/Org Revenue $400
thousand - $699 thousand: $150 / yr
Annual Co-op/Org Revenue $200 thousand - $399 thousand: $100 / yr
Annual Co-op/Org Revenue Less than $200 thousand: $50 / yr
Please choose your membership level
Individual A: $200 / yr
Individual B: $150 / yr
Individual C: $100 / yr
Individual D: $50 / yr
Choose your session(s)
Attend Both Days
Attend One Day
Session Price
$
Member Discount
$
Membership
$
Additional Attendees
I would like to register more attendees
Yes
No
Additional Attendee Contact Information
First Name
Last Name
Email Address
Phone
Add to email list
Role in Organization
Role in the organization
Director
Management
Other
If other, please specify
Choose session(s)
Attend Both Days
Attend One Day
Session Cost
$
Banquet Dinner Options for
Thursday February 2, 2023 at
Mayahuel Mexican Restauran
t
(
1200 K St, Sacramento
)
Quantity
Cost
Total Cost
Flank Steak
$
$
Pork
$
$
Shrimp
$
$
Vegetarian
$
$
Total Costs
Total Amount for Your Registration
$
Payment Information
Name on Card
Visa or MasterCard Number
MM
YY
Code
Billing Email
For more information about the conference or your membership status,
please contact CCCD at info@ccc.coop or 530-297-1032
Contact Information
ural Cooperative 
ural Cooperative