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Membership Application Form
As a registered member of
the |
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To become a member of the MCA, please fill in the blanks below and return this portion of the application with payment by mail or to an MCA board member. |
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Today’s Date (this
will be your anniversary date): |
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Membership: Individual
- $10 Family -
$20 |
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Member Name(s): |
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Mailing Address: |
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Phone #: ( ) |
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E-Mail Address: ** We take the privacy of e-mail addresses very seriously and will
not share yours with any outside party. ** ** E-mail is used
to distribute our monthly minutes and to contact members as necessary. ** |
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Would you like to
receive our electronic newsletter?
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Yes No |
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Can we contact you
for volunteer opportunities? |
Yes No |
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Member
Signature(s): |
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Payment Received
By (Board Member Signature): |
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Detach and Retain for Your Records |
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Today’s Date:
Membership Year: |
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Member Name:
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Amount Paid: $ |
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