Membership Form

*Are you a:
*Name:
*Address:
*Email Address:
*Phone Number:
If you are not already subscribed to our listserves, would you like to join: CPRC News Listserve
CPRC Playgroup Listserve
May we contact you for help with: Communications
Community Outreach
Event Planning
Event Preparation
Event Staffing
Materials Donation
Do you have any event or activity suggestions for the CPRC?
*Please let us know the names and birth dates of your children. If you are expecting, just put the month and year.
*May we include your information in the CPRC Directory?
CPRC's Membership Directory is published annually and is distributed to dues paying members only.

Our membership list is not for sale or general distribution.
Yes
No
*May we include your children's information in the CPRC Directory? Yes
No
*Payment Method: Check
PayPal
 

A survey will appear while your form is being sent. You DO NOT have to fill out the survey. Wait a moment and click "continue" at the top of the screen to continue to payment. Sorry for the inconvenience!
*Required