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Application for Associate Membership
The Application is subject for approval by the Board of Directors. Upon approval, you will be notified of acceptance.Membership dues are $200.00 per representative annually ($300.00 for two representatives) and will be made payable at the next monthly meeting to our CFCA Treasurer.

Please contact a board member with any questions.

Name of Organization:
Mailing Address:
City:
State:
Zip:
Telephone Number:
Fax Number:
E-mail Address:
Web Site Address:
Name of Representative:
Title:
E-mail Address:
Birth Date(Month/Day):
Name of 2nd Representative:
Title:
E-mail Address:
Birth Date(Month/Day):
Additional Benefits Offered:

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