2023 California Cooperatives Conference Registration

June 2-3, 2023

Mexican Heritage Plaza

1700 Alum Rock Avenue, San Jose, CA

More information about the conference including workshops, speakers, registration, sponsorships, and membership can be found on our website: www.cccd.coop

Questions? Please contact us at coops@cccd.coop or 530-297-1032.

We are looking forward to cooperating with you at the conference!!

Your Contact Information

First Name

Last Name

Email Address

Cell Phone

Your Co-op/Organization Information

Co-op/Org Name

Co-op/Org Email Address

Co-op/Org Phone

Co-op/Org Website

Co-op/Org Sector

Role in Co-op/Org

Registration ($ 30 discount for CCCD members)

I am a current member

Yes - IndividualYes - OrganizationalNo

I would like to renew my membership

YesNo

I would like to become a member

Yes - for my co-op or organizationYes - as an individualNo

Please choose your membership level

Annual Co-op/Org Revenue $1 billion & above: $750 / yrAnnual Co-op/Org Revenue $100 million - $999 million: $500 / yrAnnual Co-op/Org Revenue $3 million - $99 million: $350 / yrAnnual Co-op/Org Revenue $1 million - $2.9 million: $250 / yrAnnual Co-op/Org Revenue $700 thousand - $999 thousand: $200 / yrAnnual Co-op/Org Revenue $400 thousand - $699 thousand: $150 / yrAnnual Co-op/Org Revenue $200 thousand - $399 thousand: $100 / yrAnnual Co-op/Org Revenue Less than $200 thousand: $50 / yr

Please choose your membership level

Individual A: $200 / yrIndividual B: $150 / yrIndividual C: $100 / yrIndividual D: $50 / yr

Conference Session

Full Conference (June 2 AND June 3)Fri June 2 ONLYSat June 3 ONLY

Meal Preference

Meat okayVegetarianVeganGluten-free

Continuing Education for Attorneys

MCLE Credit ($25 for one or both days)

YesNo

Conference Price

$

Member Discount

$

Membership

$

Additional Attendees

I would like to register more attendees
($20 discount for each additional attendee from same co-op/org)

YesNo

Additional Attendee Contact Information

First Name

Last Name

Email Address

Cell Phone

Choose Session

Full Conference (June 2 AND June 3)Fri June 2 ONLYSat June 3 ONLY

Meal Preference

Meat okayVegetarianVeganGluten-free

Continuing ED for Attorneys - MCLE Credit
($25 for one or both days)

YesNo

Is your organization a current member of CCCD?

NoYes

Conference Cost

$

Total Costs

Total Amount for Your Registration

$

Payment Information

Name on Card

Visa or MasterCard Number

MM

YY

Code

Cardholder Billing Email

Contact Information