California Capital CFIDS Association
Membership Form

Please print, complete, and mail to:

California Capital CFIDS Association, Inc.
P.O. Box 660362
Sacramento, CA 95866

Phone (916) 484-3788

Date

Name

Address

City

State Zip

Phone Day Evening

E-mail

Annual Membership Dues: $15.00

    New Support Group Member ($15.00) $

    Renewal ($15.00) $

    "CFIDS Supporter"Donation (Thank You!) $

Please make checks payable to: CA Capital CFIDS Assn. (if sending in mail, Do NOT send cash)

Your contribution is greatly appreciated & is TAX DEDUCTIBLE!!

Areas of Interest?

Diagnostic/Treatment info. Neighborhood support groups

Organizing meetings Insurance problems Fundraising

Association Board Member Disability process Volunteer

CFIDS Advocacy Telephone/ Hotline Other

Return to CCCA Home page

California Capital CFIDS Association
PO Box 660362, Sacramento, CA 95866
Phone: (916) 484-3788
Email: CalCapitalCFIDS@bigfoot.com (CCCA)
Web: http://ottem.org/ccca/member.htm
Copyright 1999-2000 California Capital CFIDS Association (CCCA). All rights reserved.