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If you would like to be added to our mailing list and receive information about CAPA meetings and events, please submit your name and email address below:

CAPA Membership Form

Annual Membership Dues:

1 Year Membership - $60.00 each member
1 Year Membership - Additional Company Associates $50.00 each
2 Year Membership - 1st 5 Company Associates - $100.00 each
2 Year Membership - Company Associates over 6 - $90.00 each

Your Name

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Company Name

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Address

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City, State, & Zip Code

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Email Address

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Phone

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Today's Date

Job Title

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National APA Member
CPP
FPC

Who referred you to our chapter?

Annual Membership Dues:
     
1 year Membership - $60.00 each member
1 Year Membership - Additional Company Associates $50.00 each
2 Year Membership - 1st 5 Company Assocaites - $100.00 each
2 Year Membership - Company Associates over 6 - $90.00 each
 

List additional company associates here:
Please indicate CPP or FPC Certification and
National Membership (Yes or No)

Total Company Members

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1 or 2 Year Membership

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Total Amount Due:

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After submitting membership form, please mail a check to: 
Chattanooga Chapter of APA
PO BOX 8572
Chattanooga, TN 37414

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