This form can be submitted by email
or a PDF
version can be downloaded here.
Please note that you will still need to send a check to CAPA for dues
before you become a member. Submitting this form doesn't qualify for
membership until the dues are paid to the organization. Please note
that this form is unsecured. You may omit any personal information but
please fill out the fields with a * next to it.
Type
of Membership: New
Membership
Membership
Renewal
Information Update
PERSONAL
INFORMATION
Name:
Email:
Membership Type: Regular
Student Life
Registered Voter: Yes
No
Work
Phone:
Profession:
Home Address:
Home Phone:
Fax:
SPOUSE
INFORMATION
Name:
Email:
Membership Type: Regular
Student Life
Registered Voter: Yes
No
Work
Phone:
Profession:
Home Address: (if
same as above)
Home Phone:
Fax:
I/We would like to: Help
with association
activities.
Serve on the
board.
Referred to CAPA by:
REGULAR
MEMBERSHIP
$20/yr/person or $30/yr/couple
$
STUDENT
MEMBERSHIP
$10/yr/person
$
LIFE
MEMBERSHIP $200 one-time
fee
$
Additional
donation
$
Enter
Total
$
Chinese American Political
Association P.O. Box 4314 • Walnut
Creek, CA 94596 Tel: 925.945.1901 • Fax:
925.938.2961
