CLTA Membership - Registration

Application - Personal Information

Please provide your contact information. Your e-mail address will be used for contact, as well as your login name in the membership section of the website.

E-mail

E-mail:

Name (English)

First:
Last:

Name (Chinese)

Mailing Information

Line 1:
Line 2:
City:
State:
Zip:
Country:
Office phone:
Home phone:
Fax:

Account Information

Membership dues are related to your level of income per the table below. Please select the membership level you wish to register at.

Joint membership is available to spouses who share one set of the journal and newsletter mailed to the same address. Dues are based on the higher income, plus $30 for the second member.
If you are registering as a spouse, please provide the member ID number your spouse used to register with us:
Spouse ID:

	Yearly Income:	Annual Fee:
	$20,000 or under	$30
	$20,001 - $30,000	$45
	$30,001 - $45,000	$60
	$45,001 - $60,000	$75
	$60,001 - $75,000	$85
	$75,001 or over	$95
	LIFE Member	$900

Institution Information

Institution Information

Type: University High School Intermediate/Middle Elementary/Primary Heritage School
Name:
Department:
Country:

Institution Contact

Line 1:
Line 2:
City:
State:
Zip:
Country:
Position:
Specialty:

Submit Application

Please continue the application process using the button below: