CPSA District Chapter 114 Membership Form


      Member of National CPSA

Date: _________________

Name: ______________________________________

Address: ____________________________________


Phone: _________________ Email: ______________

Is there any part of your contact information that you would prefer not to be published in our district directory? If so, what information_______________________________________________

The annual dues for CPSA District #114 are $20.00

You can pay by a check made out to "CPSA District #114." Please fill inyour contact information above and mail both to:

Theresa Baumgartner

5837 Laurel Rock Lane

Raleigh, NC 27613-8185

Note: To become a member of a local CPSA District Chapter, you must first join the National CPSA organization. Eligibility to join a chapter is a benefit of belonging to the national organization. Their annual fee is $45.00. Go to www.CPSA.org to read more and become a member.

Link to a downloadable PDF version of this form