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.

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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

*Pronoun

She/Her/Hers

He/Him/His

They/Them/Theirs

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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

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*Membership type

New Renewal

Organizational membership - number of locations

0.00

includes 5 staff per location

1-4 locations:	$799 each location
5-13 locations:	$535 each location
ICAA 100 (14+ locations):	$6499 flat fee

Individual: $259 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, General Session, 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.

Supplier registration	On or before Aug 18	After Aug 18
Per person	$799	$899	$999

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

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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: $0.00 USD

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