Membership Payment Renewal Online Payments for Members (Renewal) Membership Type(Required) Retailer Supplier Wholesaler Company Name(Required)Billing Contact InformationBilling First Name(Required)Billing Last Name(Required)TitleBilling Address(Required) Street Address Address Line 2 ZIP Code City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific Phone Number(Required)E-mail Address(Required) Dues AmountDues are based on annual California sales from the most recent fiscal year. Gasoline sales may be excluded. Only California operations receive membership benefits. The sales volume of stores operating outside of California must be included in dues calculation for those stores to receive benefits. Contributions or gifts to CGA are not tax deductible as charitable contributions for income tax purposes, but may be tax deductible as ordinary and necessary business expenses subject to restrictions imposed as a result of association lobbying activities. CGA estimates the nondeductible portion of your dues allocatable to lobbying is 50%. CGA Tax ID# 94-0361110. Membership dues are non-refundable.This field is hidden when viewing the formIf RetailerStates Included in MembershipGross Sales Volume (In Dollars)(Required) California Sales Volume Fixed Fee Variable Fee Up To $4.9 Million $420 None $5 – $9.9 Million $420+ $81 for each full million over $5 million $10 – $49.9 Million $825+ $54 for each full million over $10 million $50 – $149 Million $2,985+ $38 for each full million over $50 million $150 – $499 Million $6,785+ $27.25 for each full million over $150 million $500 Million to $1.49 Billion $16,325+ $12.75 for each full million over $500 million $1.5 – $2.49 Billion $29,075+ $13.50 for each full million over $1.5 billion $2.5 Billion and up $42,575+ $13 for each full million over $2.5 billion Maximum $98,000 This field is hidden when viewing the formRetailer Hidden CalculationTotal Membership Price: $0.00 For Total Membership costs over $10,000, please contact Sunny Porter, CGA at [email protected].This field is hidden when viewing the formIf SupplierCalifornia Grocery Sales Volume (In Dollars)(Required) California Grocery Sales Volume Fixed Fee Supplier Executive Council (SEC) Fee (Optional) Up To $4.9 Million $850 + $650 $5 – $19.9 Million $1,700 + $950 $20 – $49.9 Million $3,400 + $1,350 $50 Million and Over $6,750 + $1,800 This field is hidden when viewing the formSupplier Fixed Fee Hidden CalculationFixed Fee Price: $0.00 Supplier Executive Council Upgrade Supplier Executive Council Upgrade This field is hidden when viewing the formSupplier Executive Council Fee Hidden CalculationSupplier Executive Council Fee Price: $0.00 This field is hidden when viewing the formIf WholesalerStates Included in MembershipGross Sales Volume (In Dollars)(Required) California Sales Volume Fixed Fee Variable Fee Up To $4.9 Million $1,425 None $10 – $49.9 Million $1,425+ $33 for each million over $10 million $50 – $149.9 Million $2,745+ $21.25 for each full million over $50 million $150 – $499 Million $4,870+ $12.50 for each full million over $150 million $500 Million – $1.49 Billion $9,245+ $5.75 for each full million over $500 million $1.5 Billion to $2.49 Billion $14,995+ $5.50 for each full million over $1.5 billion $2.5 Billion & Above $20,495+ $5.50 for each full million over $2.5 billion This field is hidden when viewing the formWholesaler Hidden CalculationTotal Membership Price: $0.00 For Total Membership costs over $10,000, please contact Sunny Porter, CGA at [email protected].Contributions & DonationsPursuant to the Political Reform Act, contributions are not tax deductible for any purpose and are voluntary (CGA GROPAC FPPC ID #760914 & IEC #1276215). CGA Educational Foundation is a 501(c)3 non-profit organization (tax ID: #68-0264745). All donations are tax deductible.GroPAC Contribution (Maximum: $9,100) Independent Expenditure Committee (IEC) Contribution (Unlimited) The maximum for IEC credit card charge is $10,000. Please contact Leticia Garcia ([email protected]) should you want to contribute more than allowed charge.For IEC contributions over $10,000, please contact Leticia Garcia at [email protected]CGA Educational Foundation Donation (Recommended $1,000) Payment InformationPrepared By(Required)TitleE-mail Address(Required) Phone Number(Required)One-time or Recurring Payment(Required) One-time Recurring Total Amount Credit Card(Required) American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name Δ
