International Council on Active Aging®

Online registration form

All membership purchases are in US dollars. For Canadian memberships, please phone the ICAA office at 866-335-9777 (toll-free) or 604-734-4466. All conference purchases are in US dollars, or download the membership application / ICAA Conference and expo application and fax or mail. A one-page membership application is available.

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*Type of form Changing form types will reset the form and clear all information entered.

*Contact first name

*Contact last name

Title

Organization/Agency name

*Address

*City

*Country

*State/Province Please select correct state

*Zip/Postal Code If not applicable, please enter N/A.

*Phone number

*Cellphone number

*E-mail address

Member number If not applicable, please enter N/A.

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Membership options

First-time members only:

Receive 10% off your individual membership or organizational membership (14 locations or less) when you become an ICAA member and register for the ICAA Conference at the same time. (To receive savings, select the mentioned category's from pull down menu above) This offer is available to first-time members only, and cannot be combined with any other offers.

* Asterisk indicates required fields.

*Membership type

New Renewal

Organizational membership - number of locations

0.00

includes 5 staff per location

1-4 locations:	$699 each location
5-13 locations:	$435 each location
ICAA 100 (14+ locations):	$5750 flat fee

Individual: $239 each - number of individuals

0.00

In the fees you pay to ICAA, $160 per person is the annual price for 6 issues of the Journal on Active Aging and a complimentary copy of the ICAA Corporate Partners Guide.

Subtotal: USD$0.00

Member referralDid a colleague refer you to ICAA? Please write name and e-mail address.

Member profileHow did you hear about the ICAA?

*Which of the following best describes your affiliation?

*Will you be expanding, renovating or moving into your community/center over the next 12 months?

Yes No

I acknowledge by submitting this membership application that I am requesting the ICAA to charge my credit card or cash my check for the amount shown on this form.

The ICAA member pledgeAs a member of International Council on Active Aging, I am committed to the philosophy of active aging and provide my residents, members, clients, and staff:

a trustworthy, safe and caring environment;
a positive vision of aging;
programs, activities and staff members to enrich their life in all areas of wellness;
education about wellness and the impact on healthy aging;
the assurance that our organization follows all relevant industry standards and guidelines for serving the health and wellness needs of our older adults;
with environments and policies that are welcoming to all ethnicities, genders, and nationalities.

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Conference registration

Registration to the ICAA Conference and Expo includes educational seminars, Main Stage events, creative exchange sessions, handouts, and wellness expo. (Does not include CEUs.)

Registration fees in US dollars. To receive group discount, all delegates from the same organization must register at the same time and pay with one check or credit card.

Sign up for the CEU program for $50 before October 20, after and on-site $60, which covers costs charged by certifying agencies.

ICAA member rates	After Aug 31
1st registration	$599
2nd and 3rd registration	$539
4th and more registration	$359

Note: If adding an additional delegate to a group that is already registered please call the ICAA at 866-335-9777 or 604-734-4466.

0.00

ICAA non member rates	After Aug 31
1st registration	$619
2nd and 3rd registration	$559
4th and more registration	$389

$0.00

Subtotal: USD0.00 *Select your organization type: (REQUIRED)

*Select your role in purchasing or leasing decisions. (REQUIRED)

Final decision

Specify brands

Recommend

No role

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Payment information

Check (payable to ICAA Services Inc.)

Immediately after submitting the application, mail your check to ICAA,
#603-1112 W. Pender Street, Vancouver, BC V6E 2S1.

The membership or conference registration will not be processed until the payment is received.

Total: USD$ 0.00

I acknowledge by submitting this application that I am requesting the ICAA to charge my credit card or cash my check for the amount shown on this form.

registration

Online registration form

Membership options

Subtotal: USD$0.00

Conference registration

Check the box of companies you want to schedule a meeting with at the ICAA Expo

Payment information

Total: USD$ 0.00

icaa 100 members