CLCAA  MEMBER APPLICATION FORM 2007 – 2008 (Annual Dues are $27.00)

Use this Application Form ONLY if you are a new member, OR if you have a new phone number,
address or e-mail that should be updated in our records.  As a new member, be sure to include your
check for $27, and make the check out to CLCAA. If you are currently a member, you DO NOT
need this form; SUAA will send you something to renew your membership.  If you are a Dues Deduction
member, you will automatically have your dues deducted from your monthly annuity beginning in September.
WE STRONGLY ENCOURAGE AL L OUR MEMBERS TO ELECT THE DUES DEDUCTION
option on the Membership Application; current members who wish to become Dues Deduction members
can complete this application form, elect the dues deduction option below,

and send it to:

Jim Beaudoin
10748-41st Avenue
Prairie View, WI 53168

Seriously consider checking the “Dues Deduction” option below. The $27 will automatically be deducted
from your monthly annuitant check, so there is no need to include a check with this application. 
Your dues will continue to be deducted each year unless you direct us differently.
This method is very convenient for all concerned.

______ Check here for “Due Deduction” option explained above.

NAME:  _____________________________________________________________

ADDRESS: __________________________________________________________

CITY, STATE, ZIP: ____________________________________________________

PHONE (Please include area code): _______________________________________

E-MAIL: ____________________________________________________________

May we include the above information in our CLCAA Directory of Members?    YES ____  NO ____

If you were recruited by a CLCAA member, please write her/his name here:

___________________________________________________________________

*The following instruction goes before the CLCAA Letter-head stationary:
This is the official copy of our CLCAA stationary.  Make extra copies, if you wish. 
Be sure to use this stationary if you are writing to legislators or to anyone else regarding CLCAA. 
ABSOLUTELY DO NOT USE THIS STATIONARY IF YOU ARE SEEKING MONEY OR DONATIONS OF ANY KIND.