New Family Membership Application Login Information Username* An email address can be used as your username. Note that usernames cannot be changed and must be unique. Password* Type your password. Minimum length of 6 characters Repeat Password* Type your password again. Primary Contact Salutation Mr.Mrs.Ms.Dr.Mr. & MrsNone First Name* Last Name* Suffix Dr.DVMJr.MDMSRVTNone E-mail* Confirm Email* Street Address City State Zipcode County Choose from the list below:AlamedaAlpineAmadorButteCalaverasColusaContra CostaDel NorteEl DoradoFresnoGlennHumboldtImperialInyoKernKingsLakeLassenLos AngelesMaderaMarinMariposaMendocinoMercedModocMonoMontereyNapaNevadaOrangePlacerPlumasRiversideSacramentoSan BenitoSan BernardSan DiegoSan FranciscoSan JoaquinSan Luis ObispoSan MateoSanta BarbaraSanta ClaraSanta CruzShastaSierraSiskiyouSolanoSonomaStanislausSutterTehamaTrinityTulareTuolumneVenturaYoloYubaOut of State Region Choose from the list belowRegion 1Region 2Region 3Region 4Region 5Region 6Out of State What CDFW region do you work in? A description of the regions is located at CDFW Regions. Phone Phone (Alternate) Affiliation What rehabilitation facility are you affiliated with? Website What year did you start in wildlife rehabilitation? Second Contact Info Contact 2 Salutation Mr.Mrs.Ms.Dr.None Contact 2 First Name Contact 2 Last Name Contact 2 Suffix Dr.DVMJr.MDMSRVTNone Email Permits and Areas of Expertise State PermitsNo State PermitsBird BandingDisplay/ExhibitionFalconryNuisance Wildlife RemovalRabies Vector SpeciesRestricted SpeciesSalvage/Special PossessionThreatened/Endangered SpeciesVenomous ReptileWildlife RehabilitationWildlife EducationDo you hold any state permits? Federal PermitsNo Federal PermitsBird BandingFalconryDisplay/ExhibitionRestricted SpeciesSalvage/Special PossessionThreatened/Endangered SpeciesUSDAWildlife EducationWildlife Rehabilitation Areas of ExpertiseAerial InsectivoresAquatic BirdsBatsBobcatCaging (Design and Construction)Columbiformes (Doves and Pigeons)Corvids (Jays/Crows/Ravens)CoyoteDeer/FawnsEaglesEducationFosteringFoxFundraisingGamebirds (Turkeys and Quail)HawksHolistic/HomeopathyHumane Wildlife ExclusionHummingbirdsKilldeerNetworkingOiled WildlifeOpossumOwlsPasserinesRabbitRaccoonRaptors (other than eagle/hawk/owl)ReptilesReunitingSeabirdsShorebirdsSkunksSnakesSquirrelsSwallows/SwiftsWaterbirdsWaterfowlWoodpeckerNoneSelect no more than 3 areas. You must have at least 3 years of experience before adding an area to this field. Please note that members may use this information to help the public locate a rehabilitator and the information will be available in our online member directory. Other Areas of Expertise Other areas of expertise not already selected above. You must have at least 3 years of experience before adding an area to this field. Please note that members may use this information to help the public locate a rehabilitator and will be available in our online member directory. Do you want the Newsletter by email only?*Yes - email onlyNo Do you want to be listed in the online directory?*Yes - List in the DirectoryDo not listFamily Member SubscriptionsChoose your level of membership. Family memberships allow two individuals to receive the special membership rate at the CCWR symposia and two votes during board elections. Family Membership - 3 years - $100 / 3 YearsFamily membership entitles two people from the household to the special membership rate at the symposium and two votes during board elections. Family membership for 3 years is $100, a $50 savings over a 1 year membership. Family Membership - 2 years - $80 / 2 YearsFamily membership entitles two people from the household to the special membership rate at the symposium and two votes during board elections. Family membership for 2 years is $80, a $20 savings over a 1 year membership.Family Membership - 1 year - $50 / 1 YearFamily membership entitles two people from the household to the special membership rate at the symposium and two votes during board elections. Family membership for 1 year is $50.Select a Payment MethodManual/OfflinePayPalAutomatically renew subscriptionSend my username and password to me via email.