CALIFORNIA ASSOCIATION OF PROBATION INSTITUTION ADMINISTRATORS CAPIA MEMBERSHIP FORM

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CALIFORNIA ASSOCIATION OF PROBATION INSTITUTION ADMINISTRATORS CAPIA MEMBERSHIP FORM CALIFORNIA

ASSOCIATION of

PROBATION

INSTITUTION

ADMINISTRATORS




CAPIA Membership Form


Renewal__________ New Member____________



MEMBERS INFORMATION (please type or print clearly)

Last Name

First Name

Title

Facility




Street Address

City

ZIP

E-Mail Address




County

Phone

Fax

Region




North ____

Central ____

South ____

Sacramento ____

Bay Area Region ____

DUES

Regular Membership (Administrators and Managers) ______

$50.00

Associate Membership (Supervisors) ______

$40.00




Mail this form and payment to:


Alan M. Crogan Youth Treatment and Education Center

Attention: Daniel Castaneda

10000 County Farm Rd.
Riverside, Ca. 92503

(951) 358-4857

[email protected]



Make check payable to CAPIA Membership


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