CSLA Membership Application
To join CSLA, please print, fill in, then mail the form below. Don't forget to mail a check or money order in U.S. dollars for the total membership dues to:

CSLA
 2920 SW Dolph Ct Ste 3A
Portland OR 97219-3962

Please circle where you wish CSLA mail sent: Home - Church - Synagogue.

Name: ___________________________________________________________

Address: _________________________________________________________

City: _______________________ State/Province: _________ Zip: __________

 

Church/Synagogue: ________________________________________________

Address: _________________________________________________________

City: ______________________ State/Province: _________ Zip: ___________

Name of Representative: ____________________________________________

Home Phone: ________________ Church/Synagogue Phone: ______________

Fax: ________________________ E-mail: ______________________________


Please send information about the nearest CSLA chapter (circle one): Yes / No

Check membership desired (prices are for January-December):

____ Individual U.S. $40
____ Individual Canadian/Foreign $45
____ Church/Synagogue U.S. $60
____ Church/Synagogue Canadian Foreign $65
____ Affiliate $100
____ Institutional $200
____ Contribution to CSLA $_________

Total (U.S. Dollars) $ ___________

$10 charge for returned checks

Please tell us how you heard about CSLA: __________________________

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