Membership Application | Maricopa Community Colleges Faculty Association

Membership Dues

Your Dues Rate Type is: Affiliate Member $120.00

Contact Information

Email *

Re-enter your email *

First Name *

Middle

Last Name *

Suffix

Informal / Preferred Name

Home Address Line 1 *

Home Address Line 2

Home Address Line 3

City *

State

Zip Code *

Country

Phone Number *

Include me in Membership Directories *
Yes No

Username/Password Username/Password

Please enter the Username/Password you would like to use to login to this website.

Your Username must be unique and must be at least 6 characters.
Passwords must be a minimum of 8 alpha-numeric characters with at least 1 number or 1 letter.

Username *

Password *

Confirm Password *

Additional Information

How did you hear about the Affiliate Membership? *

Additional Options

Consider donating to the Faculty Foundation to help meet the emergency needs of students.

Consider donating to FacPAC to help fight for causes important you.

Thank you!

FacPAC Donation: Monthly - $10 or Annually - $120.00

FacPAC Donation: Monthly - $20 or Annually - $240.00

FacPAC Donation: Monthly - $50 or Annually - $600.00

FacPAC Donation: Monthly - $100 or Annually - $1,200.00

Foundation Donation: Monthly - $10 or Annually - $120.00

Foundation Donation: Monthly - $20 or Annually - $240.00

Foundation Donation: Monthly - $41.25 or Annually - $495.00

Foundation Donation: Monthly - $82.25 or Annually - $987.00

Payment Details

Payment Method

Enter the name on the bank account according to the information shown on your bank statement. The account number and routing number can be copied from the lower left corner of the check.

Account Type

Checking

Savings

Routing Number

Account Number

Account Holder Type

Business

Personal

Business Name

Account Holder Name

By submitting payment, I am authorizing Maricopa Community Colleges Faculty Association to initiate a single or recurring ACH/electronic debit in the amount indicated from the bank account I designated above. I understand that this Authorization will remain in full force and effect until the transaction is cancelled by me by contacting Maricopa Community Colleges Faculty Association, or the ACH/electronic debit is processed from the designated account. I certify that (1) I am authorized to debit the bank account above and (2) the ACH/electronic payment I am authorizing complies with all applicable laws.

Name on Card

Card Number

Expiration

CSC

Billing Street

Billing Zip Code

Save payment method for future purchases

Total Amount Due

$

Affiliate Member Application

Membership Dues

Contact Information Contact Information

Username/Password Username/Password

Additional Information Additional Information

Additional Options Additional Options

Payment Details Payment Details

Contact Information

Additional Information

Additional Options

Payment Details