California Classical Association
Northern Section
Membership Application Form
new / renewal (circle one)
Name_________________________________________________
Address_______________________________________________
City, State Zip__________________________________________
E-Mail (Important, as many
announcements and even the newsletter will be in electronic
format).________________________________________________
School Affiliation (if
any)__________________________________
Choose Membership
Category:
Regular ($15.00)
$_________
Student ($5.00)
$_________
Retired ($5.00)
$_________
CCA-South Affiliate
Membership
$_________
($5.00 You will receive the
CCA-S newsletters as well)
Additional Contributions
to:
Grant-In-Aid $_________
Laetaberis Journal $_________
Marian McNamara
Scholarship. $_________
Total Check Enclosed (payable to “CCA-No.”) $_________
Please mail this form with
payment to:
Michael Collins
CCA-N Treasurer
30 Gloria Dr.
San Rafael, CA 94901