Full Member	$160 annual fee ($100 state, $60 region) – Open to all heads of Municipal Information Technology Organizations and/or designated Agency Representative (one vote per agency).
Associate Member	$130 annual fee ($100 state, $30 region) – Open to all Information Technology Staff (Non-voting member)

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Agency:	.
Address:	.
City, State, Zip:	.
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Full or Associate:	.

Please make checks payable to Municipal Information Systems Association of California (MISAC)
Please send a copy of this form along with a check to:

MISAC
Northern Chapter
1415 L Street Suite 200
Sacramento, CA 95814