CPA Membership Enrollment Form

New Member | Renewal | Change of Address
Name ________________________________________
Address ________________________________________
City ___________________ State______ Zip________
E-Mail ________________________________________

 
Select a membership level from the list below:
 
$25 - Basic Level Newsletter & CPA Bumper Sticker
$125 - 125 Level Basic Level + Plaque
$225 - 225 Level 125 level + Print of the Year or Shooting Shirt
$325 - 325 Level 225 Level + Statue or Jacket
$1500 - Corporate
                  Sponsor		 1 Yr Membership, 2 Meals, Hole Sponsorship at the Golf Tournament, 4 Person team at the Golf Tournament, Free Advertising
 
Enter your payment information below:
 
Check or money order enclosed
Charge my: Visa Master Card Discover
Card# _________________________________________
Exp. Date _________________________________________
Day Phone # _________________________________________
Signature _________________________________________

 

Thank you for your contribution.
 

Print this form and mail to:
Conservation Partners of America
Attn: Scott Scheidt
 1120 McLeod Ave - Glencoe, MN 55336
 (320) 864-6368