NCPT-CSLA Membership Form

Please print out the form below and send it with a check for your chapter dues ($9) to:
NCPT-CSLA Treasurer
Librarian, Mayodan Moravian
201 S. 7th Ave.
Mayodan, NC 27027-2509

Name: ___________________________________________________________

Address: __________________________________________________________

City: ________________________ State/Province: _________ Zip: ___________

 

Church/Synagogue: _________________________________________________

Address: __________________________________________________________

City: ________________________ State/Province: _________ Zip: ___________

Name of Representative: _____________________________________________

Home Phone: _________________ Church/Synagogue Phone: _______________

Fax: ________________________ E-mail: _______________________________


Check membership desired:

____ Individual
____ Church/Synagogue

Total (U.S. Dollars) $ ___________

How did you hear about CSLA?______________________________________

_________________________________________________________________