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