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Registration Form

CPSR Annual Meeting Registration Form

Name:                    
Address:                
City/State/Zip:         
Telephone:              
Email address:          




My membership status is:



$55 -------- CPSR or CCIA member

$75 -------- Non-Member

$95 -------- New CPSR membership ($50 value) & registration

$25 -------- Low income/student
NOTE: There is a $10 fee for late registrations (postmarked or e-mailed after 9-20-95) I will be sending payment (with postmark date):
on or before Sept. 20, 1995
after Sept. 20, 1995

Additional donation to further CPSR's work $

Additional comments:

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Archived CPSR Information
Created before October 2004
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USA Chapters -

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Why did you join CPSR?

I am graduating this year and want to look beyond school to see what the world has to offer.