
CWCOA Annual Conference Canceled

___New Member ___Renewal for Jan 1 to Dec 31, 20____
I, ____________________________________________________________________, wish to join CWCOA.
Business Name_________________________________________
Work Phone (______) ______-________
Address_________________________________________________
Home Phone (_____) ____-________
City__________________________State_______Zip_______________
Cell Phone (_____) ______-________
E-mail Address__________________________________________
Website Address _________________________________________
Type of Membership | Amount |
Sustaining Member (Voting) | $ 200.00 |
Regular Member Only (voting) | $ 110.00 |
Sustaining Membership & Annual Conference | $ 252.00 |
Regular Membership & Annual Conference | $171.00 |
Non-member Conference Only | $ 95.00 |
TOTAL |
Please make check payable to CWCOA and send the completed application and check to:
CWCOA, 574 Legion Street, Craig CO 81625
Conditions of Membership
To be accepted into membership, individuals must:
Note: Every new member is assumed to be in good standing unless an issue prompts a Governing Board vote. At that time the Governing Board will vote to 1) reaffirm good standing, 2) place the member on one-year probation without voting privileges, or 3) terminate membership.
Conditions for Verified Service Provider Listing
To participate in CWCOA’s website job referral list, members must:
Please include proof of business and liability insurance with application and check.
Code of Ethics
As a practicing member of CWCOA, I will . . .
Date__________________ Signature______________________________________________________
For more information about CWCOA, please see our website: CWCOA.org, or contact:
Faye Maki (Treasurer) 574 Legion Street, Craig CO 81625 or call (970) 824-5505
Authorization for Credit Card Use
PRINT AND COMPLETE THIS AUTHORIZATION AND
RETURN.
All information will remain confidential
Name on Card: ___________________________________________
Billing Address: ___________________________________________
___________________________________________
Credit Card Type: Visa Mastercard Discover AmEx
Credit Card Number: ___________________________________________
Expiration Date: ___________________________________________
Card Identification Number: ______ (last 3 digits located on the back of the credit card)
Amount to Charge: $ ________________ (USD)
I authorize ___________________________to charge the amount listed above to the credit card provided herein. I agree to pay for this purchase in accordance with the issuing bank cardholder agreement.
Cardholder – Please Sign and Date
Signature: ___________________________________________
Date: ___________________________________________
Print Name: ___________________________________________