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California Membership Form (For California Authorizers)

CALIFORNIA CHARTER SCHOOL AUTHORIZERS NACSA MEMBERSHIP FORM

California authorizers receive a 15% discount on joint NACSA/CANEC membership.  To join NACSA using this special discount, complete the information on this page and mail to Elvi Bangit, 1125 Duke Street, Alexandria, VA 22314 with the NACSA/CANEC Discount Coupon and a check, payable to The National Association of Charter School Authorizers, for the applicable dues amount.  If you are not eligible for the CANEC discount, use the regular Membership Form or the Trial Membership form.

NACSA Annual Membership Dues

Basic membership dues are $500 per authorizing agency (for one agency overseeing one charter school). The dues increase by $100 for each additional charter school that your institution oversees, up to a maximum of $5,000. Multiple campuses operating under a single charter are counted as a single school for purposes of NACSA dues.

Memberships are accepted throughout the year and are renewable annually.  To determine your dues level, complete the worksheet below.

Dues Worksheet for Voting Members
(based on the number of charter schools that your agency oversees, operating in Fall 2002):

Basic
Dues (includes one charter school):                      (a) $ 500

# of Additional Charter Schools: _____ x $100 = (b) $____

NACSA/CANEC Joint Membership Discount:  

                                                        0.15(a + b) = (c) $____ 

Total Dues = (a + b - c) = $____________

If you are applying for a NACSA/CANEC joint membership discount, please attach a completed NACSA/CANEC Discount Coupon  showing that you are a current CANEC member or are joining CANEC concurrently.

Membership Application Information

Contact Name ______________________________________________________

Title ______________________________________________________

Institution ______________________________________________________

Address _______________________________________________________

City _____________________________  State: CA

Phone ____________________ Fax _____________________

Email  _______________________________________________________

Website ________________________________________________

# of Charter Schools operating in Fall 2002 __________

# of
Campuses ______   Total Enrollment in Charters _____