Membership Registration Form Thanks for being a CRAAZ memberMembership *NewRenewalToday's Date Credentials Choose credentials you haveCTRRHITRHIAOtherOther Insert other credentials you haveFull Name *Enter First and Last namePreferred Email *This will be the email used to notify you of any updates from CRAAZ.Address *HomeWorkAddress *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryPreferred Telephone # *HomeWorkCellPhone Enter contact phone number you can be reached at.Membership Categories/Annual Dues *Choose a category that fits your membership.Active ($25.00): Primary occupation cancer registry work (abstracting, follow up or supervision). Can vote, hold office and/or chair committee.Associate ($15.00): Person interested in purpose of association. Primary occupation CANNOT be cancer registry, cannot vote, hold office or chair committee.Inactive ($15.00) An inactive member is no longer working within the cancer registry field. This category includes retirees, unemployed persons, and persons on extended leave from their cancer registry position. An inactive member shall not vote, hold office or chair a committee, but may serve on a committee.Sustaining ($50.00) – Person, institution or organization interested in promoting purpose of CRAAZ. Cannot vote, hold office, or chair a committee.Student ($10.00): Person enrolled in college level curriculum courses pertaining to medical records or cancer registry. Cannot vote, hold office or chair committee.Name of College and Program Would you be willing to serve on a committee? *YesNoMaybeWhat topics are you interested in for future CRAAZ education activities? VerificationEnter a 2-digit code to acknowledge you are not a robot. *Example: 12This box is for spam protection - please leave it blank:
