Associate Membership Application Personal Info
Home Address
Please provide us with a professional high resolution photo.
Organization Information
If your organization is not in the list, please provide a name and address below.
Work Address
Primary email is the email that CCHL will use for correspondence with you.
Education Information
(if you chose Other Certificate/Diploma for education you may supply the diploma received here)
Updating your Login Information
You may create or change your user name and password by entering a new username and password below.
Your user name and password must be system unique and must be at least 6 characters long and cannot begin with a space.
Your password should be a minimum of 6 characters and must contain letters, numbers and symbols. We recommend that you avoid using any part of your user name in your password.
Login Information