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Is there any part of your contact information that you would prefer not to be published in our district directory?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