2012
Central Coast Claims Association
Membership Application
Individual
Associate Membership Annual Dues: $75.00
Corporate Membership (Unlimited Individuals) Annual Dues: $150.00
For Membership payment by check, this form must be printed, filled-out, and mailed
to
the address below, along with your check...Or, bring it with you to the next
meeting.
You May Now Join the CCCA by Credit Card
Name:_____________________________________________________
Mailing Address:____________________________________________
City:_______________________ State:______
Zip:________________
Business Phone#: ___________________________________________
Business Fax#:______________________________________________
Email:_____________________________________________________
Company Affiliation: ________________________________________
Current Position:____________________________________________
Membership
Benefits Include:
- A free
subscription to the monthly
Central Coast Claims
- Priority
registration for the Golf Tournament
-
Discounted
luncheon costs
-
Continuing
Education and Industry Training
|
|---|
Individual
Associate Membership Annual Dues: $50.00
Individual
Adjuster Membership Dues: $25.00
Corporate Membership (Unlimited) Annual Dues: $100.00
Additional Names for Corporate Memberships
Name:
_______________________________________ |
Name:
_______________________________________ |
Name:
_______________________________________ |
Name:
_______________________________________ |
Please make checks payable to C.C.C.A. Application and check should be mailed to:
Central Coast Claims Association
c/o 2011 Membership Chair, Shelly Lefore
5669 Snell Ave. PMB 384
San Jose, Ca 95123
Federal ID# 91-2031381