** If you are already a member of CCA but would like to become a member of CAMECD
please print out the bottom portion of the page, fill it out and return it to the address listed. **
Name ___________________________________ Telephone ___________________________________
Title ____________________________________ Institution ____________________________________
Street Address ________________________________________________________________________
City _______________________________ State _________ Zip ________________________________
Signature _____________________________________________ Date ___________________________
CCA One-Year Membership: $120.00
CAMECD One-Year Membership: $10.00
(__) My Check is Enclosed (Please make check payable to CCA-CAMECD for $130.00)
(__) Please Charge My Credit Card
(__) Visa (__) MasterCard
Account Number: ____________________________________
Expiration Date: _____________________________________
Card Holder's Signature: ______________________________________________
Please send this completed form to:
California Counseling Association
543 Vista Mar Avenue
Pacifica, CA 94044
(__)Yes! I want to Join CAMECD today!
Name ___________________________________ Telephone ___________________________________
Title ____________________________________ Institution ____________________________________
Street Address ________________________________________________________________________
City _______________________________ State _________ Zip ________________________________
Signature _____________________________________________ Date ___________________________
If you are a member of CCA please send this completed form with your check for
$10.00 payable to CAMECD to:
California Counseling Association
543 Vista Mar Avenue
Pacifica, CA 94044
