MEMBERSHIP APPLICATION

To pay by "Check or Money Order" fill out the membership application below and mail to:

Mail-In Membership Form

CCDS Membership Department
6422 Irwin Ct.
Oakland, CA 94609

First Name: ____________________________________________

Last Name:_____________________________________________

Street Address: __________________________________________

City: _________________ State:___________ Zipcode:__________

Country: ________________________________________________

Organization: ____________________________________________

Phone: _________________________________________________

E-mail: _________________________________________________

Check the Membership Level that applies to you.

Low Income/Student/Unemployed: Yearly Membership__$ 18.00.

Individual/Single: Yearly Membership__$ 36.00.

Household/Family: Yearly Membership__$ 48.00

Make checks payable to "CCDS"