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2018 CCA Membership and Convention Registration Form

Please print or type the registration/membership form and return it with your dues and convention fees. Submit
one form per person. Note that the information you provide will be included in the online CCA Directory.

Name: __________________________________________________________________________________________________________________

Current Institution: _______________________________ Title: _________________________________________________________________
Student: Undergraduate: ____________ or Graduate: _____________
Highest Degree Earned: ________________ From: ___________________________________________________ Year: _____________
Work Address: __________________________________________________________________________________________________________
City & State: _____________________________________________________________________________________________________________
Office Phone: _____________________________________ e-mail: ______________________________________________________________
Interest Areas: ___________________________________________________________________________________________________________
Fee Information (Please check both the Membership and Convention Fee categories.)

Membership Fee
___ Regular $15.00
___ Student $5.00 Fee:
___ Sustaining* $20.00
*Sustaining does not include
___ Life $250.00 convention fee. It’s for ___ Institutional $30.00
(Life Members do not pay additional members who want to provide
membership or convention fee) additional support to CCA.

Convention Fee
___ Member Early Registration Conference Fee:
___ Member Regular Registration $45.00
(postmarked by Sept 1, 2018) $35.00
___ Non-Member registration $70.00 ___ Student Registration $15.00

___ Life member planning to attend the convention $0

___ Renewing Membership but NOT planning to attend the convention $0

Ray Camp Award
Mary E. Jarrard Prize
General donation

Total Due for Membership, Registration, & Donations

Make checks payable to Carolinas Communication Association.

Please mail form and fees to:
Carol Leeman (; 704-687-0773)
Department of Communication Studies, UNC Charlotte
9201 University City Blvd., Charlotte, NC 28223

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