COPOAC Membership Information
Thank you for your interest in joining the COPOAC!
Please print out and complete the form below for membership approval. Form can be delivered at an event, or mailed in to the address listed on the form.
You can email us with any questions at:
contact@copoac.org
COLORADO POA CLUB
Membership Form for 2010 Please Print: Family Name ______________________________________________________ Mailing Address: ___________________________________________________ ___________________________________________________ Home Phone: __________Work Phone: _________ Fax: __________ Email address: _______________________________ In an effort to save the club money, we would like to send the newsletter by email please indicate if this OK ____ yes ____ no Family Members Birth Date: M/D/Y ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Make checks payable to: CPOAC and mail this membership form with your dues of $35.00 to: Debbie Lange 1431 S. Haymaker Dr. Milliken, CO 80543 Questions? Call Debbie at 970-587-8805 Cell 303-709-1107
