Sacramento Head Start Alumni Association

CHSA MEMBERSHIP APPLICATION

Sep 13, 2002

CALIFORNIA HEAD START ASSOCIATION
MEMBERSHIP APPLICATION
January 2002-July 2003
1. NAME:
GRANTEE/DELEGATE AGENCY:
Check all that apply below:
Parent $ 15 Grantee/Delegate:
Friend $ 50 Over $10M budget $ 750
Staff $ 40 Over $ 5M budget $ 500
Director $ 60 Over $ 2M budget $ 300
Student $ 30 Under $ 2M budget $ 150
2. ADDRESS:
3. PHONE: Home ( ) Work ( ) FAX ( )
4. E-MAIL ADDRESS:
5. TOTAL AMOUNT ENCLOSED: $
Please remit checks for dues and this application to:
CHSA Membership
c/o Ed Condon, Ex.Dir.
926 ?“J?” Street, Suite 1119
Sacramento, CA 95814