CAPS Membership Form

Print this page and Send in your dues NOW.... 

CAPS MEMBERSHIP APPLICATION/ INFORMATION

Name:_________________________________________ Phone:___________________

Address:________________________________________________________________

City:__________________________________________ State:____________________

AMA#_____________________________ NMPRA#____________________________

Email Address:___________________________________________________________

DOB:______________ Your Club Name:______________________________________

City/State:_______________________________________________________________

ANNUAL DUES: OPEN MEMBERSHIP…………………………………………$25.00

Spouse or Friends Dues………………………………………………………………$5.00

Name:_____________________________________________ DOB:________________

Please complete the above information and return it with your money.

Make checks payable to: Sandi Frazer C/O Caps @

2306 Meadow Ridge Ct Wheelersburg, OH 45694