YEAR________
Individual Membership $20.00
Name: _______________________________________
Affiliation: ____________________________________
Address:
______________________________________
_____________________________________________
Telephone: ____________________________________
Fax: _________________________________________
Email address: _________________________________
Agency
Membership $55.00
Agency Name: _________________________________
Contact: _______________________________________
Address: _______________________________________
______________________________________________
Telephone:
____________________________________
Fax: __________________________________________
Email Address: _________________________________
Make
checks payable to: Alameda County Child Abuse Prevention Council,
and
send check and form to:
Alameda
County Child Abuse Prevention Council
Eden
Multi-Service Center
24100
Amador Way
Hayward,
CA 94544
510-780-8989
