Membership Application

to The Redwood Empire Foster Parent Association and The California State Foster Parent Association

CHAPTER NAME___CHAPTER 21_______ DATE________________

NAME______________________________________________________

SPOUSE (or Significant Other) NAME____________________________

PHONE_____________________ FAX #__________________________

ADDRESS_________________________________________________

CITY_________________________________ ZIP__________________

EMAIL ADDRESS___________________________________________

Please circle the membership type you desire below

• REGULAR MEMBER (Foster Parent residing in Sonoma County)
  • Family ($50)
  • Individual ($35)
• CSFPA ASSOCIATE MEMBER (Concerned citizen) ($50 Per Person)
• AGENCY PERSON ($35)
• CORPORATE MEMBER
  • Please contact REFPA for membership information and rates.

________________________________ _________________________________ Signature(s) (All Persons, as shown on license, must join if one joins, per CSFPA Bylaws/Operating Procedures)

Please print this page and send application and monies to:

REFPA Membership, P.O. Box 1084, Santa Rosa, CA 95402.

For more information, please call (707) 528-3672.