California Classical Association

Northern Section

 

 

 

 

Membership

Application Form

Please Check One:                  q New                        q Renewal

 

Name:  __________________________________________________________________

 

Please Check One:   q  Home Address          q  Work/Office/School Address

 

Street:  __________________________________________________________________

 

City, State, ZIP:  __________________________________________________________

 

Please Check One:   q  Home Phone              q  Work/Office/School Phone

 

Phone Number:  __________________________________________________________

 

Email Address:  __________________________________________________________

 

School Affiliation:  _______________________________________________________

 

Please Check Your Membership Category:

 

q  Regular   $15.00                                                                        $ _________

 

q  Student    $5.00                                                                          $ _________

 

q  Retired    $5.00                                                                           $ _________

 

Please Also Consider:

 

q  Affiliate Membership with CCA-South    $5.00                        $ _________

 

q  Grant-In-Aid                                                                                  $ _________

 

q  Laetaberis (Journal of the CCA)                                                   $ _________

 

q  Marian McNamara Scholarship                                                     $ _________

 

      TOTAL                                                                                         $ _________

 

Please mail this form and your check payable to CCA-North to:

 

Benjamin Schalit, Treasurer

California Classical Association — Northern Section

6415 Schmidt Lane Apt. B210

El Cerrito, CA  94530