CAAC APPLICATION

Membership Information


Please accept my application for membership in the CAAC

Individual $10.00

Couple $20.00

Family $25.00

 __ New __ Renewal


Name: ______________________________________________

Address:_____________________________________________


City:________________________________________________


State:_______________________ Zip:____________________


Phone:______________________ Cell:____________________

Email:_______________________________________________

Total Enclosed:_______________________________________

Please check areas of interest:

__ Arts/Crafts		 __ Writing __ Music

__ Photography		 __ Performing Arts __ Computer

__ Other: (explain)_____________________________________

Additional Family

Spouse:_____________________________________________


Dependent Child:______________________________________

Dependent Child:______________________________________


Dependent Child:______________________________________

Dependent Child:______________________________________

Dependent Child:______________________________________