Membership Application Form

Membership Form

July 1, 2025 - June 30, 2026
Organization*
Organization Name
We hereby declare our intent to participate in the Consortium Ethics Program at the following level:
prevnext( X )
Institutional Membership2 participants and all benefits
$6,600.00 Quantity



Additional Participantsper person - Institutional Membership also Required
$1,950.00 Quantity



Individual Membership per person (all benefits except on-site programming)
$2,200.00 Quantity



a la Carte, Onsite Programming4 hours of on-site programming only
$2,500.00 Quantity



a la Carte, Workshops Onlyper person (retreat and onsite/online programming not included)
$1,500.00 Quantity



Total

$0.00
We understand that the Institutional and Individual membership options above require the designation of participants from within our organization to attend CEP conferences, seminars and training sesssions during the course of membership and we agree to providing administrative support to said participants by providing them with required release time to attend the above conferences, seminars and training sessions.
Administrative Authorization (CEO/CFO/COO)*

First NameLast Name
Address*

Street Address

Street Address

CityState

Postal/Zip Code
E-mail*
example@example.com
Cellular Number
Work Number*
Billing Adress

Use the address above.I want to specify a different billing address.
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date*

MonthDayYear
Should be Empty:

Membership Form