Print this page

To become a CPA member print this application, fill it in and send it, along with your check, to the address listed below.

2012 MEMBERSHIP APPLICATION

Name _____________________________________________________

Address ____________________________________________________

City                                                     State                        

Zip______________

Daytime telephone  (           )                                                               

If you would like to receive "save the date" information, program brochures, newsletters by email please include your email address. Your email address will not be shared with any other organization or company.

 E-Mail address:                                                                                 

Referred by:                                                                                        

 CPA MEMBERSHIP DUES: $25.00

MAKE CHECKS PAYABLE TO: CPA

MAIL TO:

Gwyn Muscillo
19 Buena Vista Street
Unionville, CT 05085

FOR INFORMATION CONTACT:

Jane Montgomery . . . jtmontgomery37@cox.net