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Get Cappa Affiliate Member Application 2012-2013

Individual (No affiliation) Company: Address: City, State, Zip: Phone: $1000 $100 Total amount due: $ Fax: Website: Key Contact Name: Make checks payable to CAPPA I am interested in paying by credit card (processing fees apply). Credit card invoice will be sent if box is Phone: checked. Email: Email: Please read and sign below 1. Affiliate membership in CAPPA is open to entities or individuals providing services and products to the subsidized child care field. 2. Affiliate member.

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