Please type your information into the form, print it, and sign the bottom. You may click "Clear/Reset Form " to clear all entries when done.
Name: ACA # Date of Birth:
Name (spouse/other): ACA # Date of Birth:
Address (Street): Address (City, State, Zip):
Phone #: E-mail: Please retype your e-mail to confirm it:
Please add me to your "News Flash" e-mail list: Yes No
Emergency Contact: Phone: Relationship:
Names & Birthdates of children under age of 18 who will be participating (ACA requirement; please don't type into the non-visible area--it won't print): e.g., Jill, 4/12/90; Jack, 7/24/92
Type of Membership: Individual = $35 Family = $50 Business = $50 (Membership is valid for a one-year period from the date dues are paid.)
Note: Requires Signed Waiver and Release of Liability — One Per Member!
After reading, completing, and printing the membership form and the required waivers, please sign the forms, and mail all pages with your check (payable to "CCPAC") to: CCPAC, PO Box 803, Traverse City, MI 49685-0803