To apply for membership, click PRINT on your browser, fill out the form below, and mail or fax it to us, along with your check. |
Name: ___________________________Phone:_____________________
Lab or Business Name: ________________________________________
Business Address: ___________________________________________
City: ____________________________ State: ______ Zip: ___________
Name of person who will represent your firm:________________________
Number of technicians (excluding yourself) _________________________
Applicant's signature: ____________________________Date: _________
___ Active member ___ Affiliate ___ Associate _____ Docent
Total initiation fee enclosed $____________
In what capacity can you best serve CDLA?
| ____ Component Chairman | _____ Education |
| ____ Legislative | _____ Phone Tree |
| ____ Other (Specify) _________________________________________ | |
MAKE CHECK PAYABLE TO CDLA
$32.00 per month (plus 1.50 per bench technician)
____ Visa ____ MasterCard
Account # _______________________ Exp Date ________________
Signature: _______________________________________________