SCAN II Membership Application

All information listed below will appear on the SCAN website.

The membership fee is for one (1) person per company. If more than one (1) person from your company wishes to attend the SCAN meetings, either a $5 guest fee per meeting will be charged or an additional membership fee of $35 for the year will be required.

An asterisk (*) denotes a required field. Please Note: We respect your privacy. Your contact information will not be sold or traded.

New Membership

	SCAN II Membership Dues - $ 35.00
	SCAN I & SCAN II Membership Dues - $ 70.00
	(Your initial membership fee will be processed once you complete the confirmation step. You will be able to cancel automatic renewals at any time by logging in to your account or contacting us.)

I will send payment by check.

Email Address *

My Contact Information

This information will not appear on the website. It is only collected in case we need to reach you concerning your membership.

First Name *

Last Name *

My Street Address

My City

My Zip Code

Home Phone

Mobile Number

Your payment information will be collected after confirming the above information on the next page.


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SCAN II Membership Application

All information listed below will appear on the SCAN website.

Member Login