California
State Care Providers Association
Serving Children - Foster Parents - Adoptions - Guardianship - Kinship
California
State Care Providers Association
Serving Children - Foster Parents - Adoptions - Guardianship - Kinship
Aubrey Manuel, President
Telephone (323) 846-0007
Email: cscpa@fosterparents.com
CHAPTER MEMBERSHIP FORM (Please Print)
Click here to download printable membership form
Date ______________
Association Name _________________________________________ Chapter Number _______
Address _______________________________________ City ___________________________
County _________________________________ Phone ______________ State _____ Zip _____
Chapter Employee Identification Number ______________________________________
THIS MUST BE COMPLETED
President _____________________________________ Phone (______)________________
Address ________________________________ City ______________________ Zip ________
Vice-President _____________________________________ Phone (______)________________
Address ________________________________ City ______________________ Zip ________
Secretary _____________________________________ Phone (______)________________
Address ________________________________ City ______________________ Zip ________
Treasurer _____________________________________ Phone (______)________________
Address ________________________________ City ______________________ Zip ________
Membership Chair _____________________________________ Phone (______)________________
Address ________________________________ City ______________________ Zip ________
CHAPTER DUES AND INCOME TAX INFORMATION
_____ AFFILIATE CHAPTER: Dues $25.00 An association that operated under its own Nonprofit Status. CALIF ORGANIZATION NUMBER __________________.
_____SUBORDINATE CHAPTER: Dues $50.00 An association that operates under the California Caregivers Association Nonprofit Status. Subordinate Chapters are responsible to send SEMI-
ANNUAl REPORTS to CSCPA. Copies of all Financial Contracts, Grants, Fund raising Reports, Tax letters and Tax Reports.
The signatures below signify affirmation in regard to this Chapter's Income Tax Status.
_____________________________________________ ___________________________________
PRESIDENT DATE TREASURER DATE
Please send this form with a check to: Mail to: CSCPA, P.O. Box 4776, Chatsworth, CA 91313
Please include a TYPED roster of paid members: Name, address, city, zip, phone + area code
© 1999/2008 CSCPA