Information Verification-2025

2025 Membership Dues Renewal Questionnaire
Thank you for your support of Cal-Lab Association through membership.

NEW FOR 2025 RENEWALS this form MUST be completed and returned with your 2025 membership dues payment. Your dues will not be processed until this form is received. Please note THIS IS NOT A MEETING REGISTRATION FORM, The additional information requested will be used to help the board better understand the membership's demographics, to update your membership profile, and your individual information will not be shared.
Have you been a member of Cal-Lab Association in the last 5 years?*

YesNo
Thank you for your interest in Cal-Lab Association! You will need to fill out a new member application located under the membership section of our website (www.cal-lab.org) rather than this dues renewal form.

Laboratory Representative Information
Primary Representative: This is your official contact authorized to receive and respond to membership and other official correspondence from the Cal-Lab Association.
Name*
CDT #
Email*
example@example.com
Primary Rep Cell*
Please enter a valid phone number.
Billing Representative: This is your official contact authorized to receive all Cal-Lab invoices (if different from primary contact)*

My billing representative is the same as my primary representativeI have a different billing representative
Billing Rep Name
CDT #
Billing Rep Email*
example@example.com
Billing Rep Cell
Please enter a valid phone number.

2025 Membership Dues Renewal Questionnaire