Membership: Member Information

Enter Member Contact Information:

First Name:  *
Last Name:  *
Club/Business Affiliation:   (optional)
Street Address:  *
City:  *
State:  *
Zip:  *
Email:  *
Phone:  ()-*

Enter Other Member Information:

Registered Voter?  Yes:  No: 
Veteran?  Yes:  No: 
Help at CMRA events?  Yes:  No: 

The information for the next three items can be found on your membership card, or above your name in the mailing label area on the back of your newsletter. If this information is not available, please enter an "X" in each field.

Member Number:  *
Years as Member:  *
Expiration Date (yyyy/mm):  *
Enter Your Message Here (optional): 

Fields marked * are required.

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