New Individual Membership Application If you choose manual payment method at the bottom of this form, make your check payable to “CCWR” and mail it to: CCWR c/o Ruth McDunn 1482 Hugo Lane San Jose, CA 95118 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? What year did you start in wildlife rehabilitation? Permits and Areas of Expertise State Permits*No State PermitsBird BandingDisplay/ExhibitionFalconryNuisance Wildlife RemovalRabies Vector SpeciesRestricted SpeciesSalvage/Special PossessionThreatened/Endangered SpeciesVenomous ReptileWildlife RehabilitationWildlife EducationDo you hold any state permits? Federal Permits*No Federal PermitsBird BandingFalconryDisplay/ExhibitionRestricted SpeciesSalvage/Special PossessionThreatened/Endangered SpeciesUSDAWildlife EducationWildlife RehabilitationDo you hold any Federal permits? Areas of Expertise*Aerial 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.Preferences 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 list Do you want to subscribe to the Gaggle Listserve?*Yes - subscribeNo - do not subscribeHOW IT WORKS When you send an email to firstname.lastname@example.org every subscriber will get the email message. If you reply to a message, every subscriber of the list will receive the email (like "reply all"). There will be a link at the bottom of each message you if you want to reply directly to the subscriber and not the entire list. It is good practice to include your name, location and affiliation on all messages. Only active CCWR members are allowed to participate in this unmoderated list.Individual Member SubscriptionsIndividual Member - 3 years - $65 / 3 YearsIndividual membership entitles member to the special membership rate at the symposium and one vote during board elections. Individual membership for 3 years is $65, a $40 savings over a 1 year membership.Individual Member - 2 years - $50 / 2 YearsIndividual membership entitles member to the special membership rate at the symposium and one vote during board elections. Individual membership for 2 years is $50, a $15 savings over a 1 year membership.Individual Member - 1 year - $35 / 1 YearIndividual membership entitles member to the special membership rate at the symposium and one vote during board elections. Individual membership for 1 year is $35.Automatically renew subscriptionSelect a Payment MethodManual/OfflinePayPalNo payment methods are available for the selected subscription plan. 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