|
Cost:
|
|
- $252
($21 per month)--For employees whose charter school is a CANEC
member
|
|
- $276
(23 per month)--For employees whose charter school is NOT a
CANEC member
|
|
| Name:
______________________________________ |
|
| SS
#: ______________________________________ |
|
| Birthdate:____________________________________ |
|
| Charter
School:_______________________________ |
|
| Job:_________________________________________ |
|
| Address:_____________________________________ |
|
| City:________________________________________ |
|
| State:_______________________________________ |
|
| Zip:_________________________________________ |
|
| E-mail:______________________________________ |
|
| Phone:______________________________________ |
|
| Fax:________________________________________ |
|
| |
|
| Payment
Options |
|
- Check
enclosed for the annual membership dues made payable to: CANEC
- Credit
Card Payment
Mastercard
/ VISA
|
|
| Credit
Card #__________________________________ |
|
| Expiration
Date________________________________ |
|
| Signature:____________________________________ |
|
|
|
|
| |
|
| What
additional benefit products would you like more information about: |
|
- 403
(b) Tax-deferred Annuoity
- Long
Term Care Coverage
- Catastrophic
Insurance Plan
- Living
Trusts
- Life
Insurance
|
|
| |
|
| Please
send your membership form to: |
|
CANEC
1139 San Carlos Ave., #304
San Carlos, CA 94070
|
|
| or
fax the information to :650-654-4267 |
|
