CSUSB Authorize.net Payment Form

Are you sure you want to leave this form and resume later?

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

You must upload one of the following file types for the selected field:

There was an error displaying the form. Please copy and paste the embed code again.

There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.

Membership Type*

Membership Level*

Coyote Pack (CSUSB Student) – FREE Senior Citizen (Individual w/ discount) - $35 CSUSB Alumni (Individual w/ discount) - $35 Individual - $50 Dual - $85 Family - $100 Associate - $150

Member Focus*

Name*

Prefix (optional)

First Name

Last Name

Name (Dual Membrship)*

Prefix (optional)

First Name

Last Name

First Child Name

First Name

Last Name

Second Child Name

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Email*

Phone*

How did you hear about RAFFMA Membership?

Decline to Answer RAFFMA Website Mailing Museum Front Desk CSUSB Faculty/Staff Current RAFFMA Member

Other:

Payment

Senior Citizen Membership $

CSUSB Alumni Membership $

Individual Membership $

Dual Membership $

Family Membership $

Associate Membership $

Total $

Billing Information

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Credit Card*