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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:
California
Classical Association — Northern Section
6415 Schmidt Lane
Apt. B210
El Cerrito,
CA 94530