Return to Membership Information | Home Page. To be printed out, completed, and submitted by mail

Membership Application Form for Calendar Year: (          )

Yes, I would like to join The Center for Continuing Adult Learning for the Calendar Year indicated above, and participate in the learning experiences offered. I understand that the membership fee is $100 for the calendar year (January 1 through December 31).

1. Enclosed is my check for $                          |     2. New (     ) or Renewal (     )?

3. Specify exactly how you wish your mailings to be addressed:
     Mr. (     ), Mrs. (     ), Miss (     ), Ms. (     ), Dr. (     ), Rev. (     ), Other:

4. Name:

5. Address:

Town; State; Zip Code:

Phone #: (          )                                   | FAX #: (          )

E-mail:

6. Winter address: (if different) from (dates)      /     /           to      /     /          .

Address:

Town; State; Zip Code:

7. What "call name" or "nick-name" do you want on your name tag?

8. For "Renewals" Do you need a new or replacement Name Tag? (yes or no)

9. Are your retired? (yes or no)               What was your former occupation?

10. Please indicate your interest in serving The Center in any of the following areas:

• Facilitating a course. Subject:


• Serve on: (     ) Board of Directors; (     ) Nominating Committee; (     ) Curriculum Committee; (     ) Finance and Administration Committee; (     ) Membership and Promotions Committee; (     ) Classroom Assistant; (     ) Volunteer for occasional office work.

11. What do you enjoy doing in your "spare" time? Do you have an interesting hobby?

12. Do you want to be on the list to receive notices of CCAL trips? Yes_____ No_____

Return this form with your check made payable to CCAL to:
The Center for Continuing Adult Learning (CCAL), PO Box 546, Oneonta, NY 13820
Questions? Call our office (607) 441-7370; FAX to (607) 436-9682; or E-mail us at ccaloneonta@stny.rr.com
Our office hours are Tuesday, Wednesday and Thursday only from 12:30 to 4:30 p.m.