CPWQA - APPLICATION FOR MEMBERSHIP
Name
Title
Organization
Business Address: (For all mailings & directory listing)
Street
City
State Zip
Telephone Number
Fax
Home Address: (This address is not required but if you want mailings, such as the newsletter, to be sent to your home fill in the following. The directory will, however, indicate your business address.)
Street
City
State Zip
Telephone Number
Fax
Send completed application and a $15.00 check made payable to CPWQA to:
P.O. Box 505
Mechanicsburg, PA 17055
Yes No Are you interested in serving in a committee?