CUPSFA Membership Form

Check one:  [ ] new member    [ ] renewal


Check type of membership (select one of the following):

Junior (under 18): [ ] $ 5 per year

Regular:           [ ] 1-yr $ 15   [ ] 2-yrs $ 20  [ ] 3-yrs $ 25

Senior (over 59):  [ ] 1-yr $ 10   [ ] 2-yrs $ 15  [ ] 3-yrs $ 20



Name:______________________________ Phone:_______________

Street Address:__________________________________________

City, State:_______________________________ Zip:_________