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2004-2005 DCCA Membership Form

PLEASE PRINT AND RETURN THIS PORTION WITH PAYMENT TO: 

DCCA

P.O. Box 335

Middletown, DE   19709

Name of School/Organization:  ________________________________________________________________

Number of members:  ____________________

Amount Enclosed:  ______________________

Name of member(s)                                            Type of Membership (circle one)

_______________________________                FULL       INDIVIDUAL       GROUP

Address:

Phone: (list all that apply)

email address:

_______________________________                FULL        INDIVIDUAL       GROUP

Address:

Phone: (list all that apply)

email address:

(PLEASE USE THE BACK OF THIS FORM IF YOU NEED ADDITIONAL SPACE)

REGISTRATION MUST INCLUDE NAME, ADDRESS, AND HOME PHONE NUMBER FOR EACH OF THE PEOPLE YOU ARE REGISTERING FOR YOUR TEAM.  REGISTRATIONS WILL BE RETURNED IF ALL NECESSARY INFORMATION IS NOT COMPLETE.