(a California Nonprofit Public Benefit Corp./ Not Tax Exempt)

Member's Name: ___________________________________________

Address: _________________________________________________

City: __________________________________, State: _________

Zip: ______________ email: _______________________________

Telephone 1:_______________ Telephone 2: _________________

Additional Information: __________________________________

__________________________________________________________

__________________________________________________________

Please indicate the ONE chapter you wish to be associated
with:

__ Central Coast   __ San Francisco    __ East S. F. Bay
__ Kern County     __ Inland Empire    __ Sacramento
__ Orange County   __ San Diego        __ Sierra Foothills
__ Silicon Valley  __ West Los Angeles __ South Los Angeles
 

Check all that apply:

___ New member

___ Renewal ($40/yr) - Prior Chapter: _______________________

___ Gift Membership

___ Donation Only

___ $50 yearly dues enclosed

___ Additional donation enclosed: _______
 

Name(s)/Address(es) of other(s) who may be interested in COPS:

______________________________________________________________

______________________________________________________________

______________________________________________________________

Mail to: Coalition of Parent Support, 2214 Arden Way, Suite 197 Sacramento CA 95825-3302