Join the CCCA

2006 Central Coast Claims Association
Membership Application

This form must be printed and then filled out and mailed to the address below, along with your check...

Or, bring it with you to the next meeting.

Check one for each:

Regular Member
New Member

Associate Member
Renewing Member

(A "Regular Member" is someone employed as a claims representative or private investigator.
All others are "Associate Members". membership covers the calendar year through December 31, 2006)

Name: ___________________________________________________________

Home Address: ____________________________________________________

City: ____________________ State: _______ Zip ___________

Home Phone # (____) ____-__________

Company Affiliation: _______________________________________________

Mailing Address: __________________________________________________

City: ____________________ State: _______ Zip __________

Business Phone # (____) ____-__________ Ext.# _________

Fax# (____) ____-__________ E-mail _________________________________

Current Position: __________________________________________________

Your membership includes:

1) Monthly copy of Association News Network
2) Luncheon rate of $18.00 (with reservations)
(non-members $23.00)
3) Priority ticket purchase for annual Golf Tournament and other Special Events

Please make checks payable to C.C.C.A.
Application and check should be mailed to:

Central Coast Claims Association
c/o Tami Murzi
Restoration Management
32550 Central Avenue
Union City, CA 94587
510.315.5458

Federal ID# 91-2031381

*A Regular Member is someone employed as a claims representative or private investigator. All others are Associate members. Membership covers the calendar year through 12-31-06

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