CAHN MEMBERSHIP APPLICATION Pay By Check/Purchase Order/Cash: Complete this form online then click "Submit Application" at the bottom of page   HAND WRITTEN FORMS ARE NO LONGER ACCEPTED Are you a renewing member?* Yes No
Membership Type*
Regular Member - $40 a year Associate Member - $40 a year Honorary Lifetime Member - No Charge Membership type? click here	Amount to be submitted: $ Payment for:*     (7/1/2019- 6/30/2020)
Member Information
Last Name* Title / Rank County	First Name* Agency/Company* P.O.S.T. ID #
Select Your Region*   Northern California (Monterey County, Kings County, Tulare County, Inyo County and all counties North)   Southern California (San Luis Obispo County, Kern County, San Bernardino County, and all counties South)   In the United States, but Outside California   International
Address / Contact Information
Mailing Address* State / Province* MEMBER Email Address* Supervisor/Training Coordinator Email Address Contact Phone*	City* Zip / Postal Code* Cell or Pager
Comments / Suggestions
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After you click "Submit Application", a window will pop-up instructing you to print the form. Your membership application is not complete until we receive this application and your annual dues payment. HAND WRITTEN FORMS ARE NO LONGER ACCEPTED MAIL FORM AND PAYMENT Payable to: CAHN Membership, PO Box 10118, Moreno Valley, CA 92552-0118 California Tax ID #95-4311160