Events

CBOA Membership Application Form

Submitted by admin on Tue, 08/08/2023 - 14:06

CBOA Membership Application Form for Fiscal Year 25/26. Please complete and SUBMIT the form below,****DO NOT MAIL IN A COPY OF THE COMPLETED FORM ALONG WITH YOUR PAYMENT**** Please make all payments by check payable to "CBOA" and Mail to: CBOA P.O. Box 1054, Branford CT 06405

Membership: *

New Member

Returning Member

Membership Type: *

Active Member, $45.00

Associate Member, $55.00

Retired Member, $10.00

Life Member, Free (Must be approved by Executive Board)

First and Last Name : *

Enter First and Last Name

Mailing Address: *

Enter Street Adress

City, State Zip Code: *

Do not change value

Phone Number: *

E-Mail Adress: *

Provide e-mail address

Municipality or Firm you represent: *

Municipality of Fire you represent

Current Posistion: *

Payment: *

Check

PayPal

Cash at meeting

Total Amount: *

Check Number: *

For PayPal and debit/Credit Card Payments, Please Submit your request and select Pay with PayPal on the following screen.

Number of Memberships included within this payment: *

PP-ID:

CAPTCHA

This question is for testing whether you are a human visitor and to prevent automated spam submissions.

Math question: * 12 + 1 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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Newsletters: The deadline for the newsletter is on the 15th of the previous month. Please get your info to Anthony Cinicola at acinicola@branford-ct.gov The more reporters the better, so send in your notes and get a by-line.

NOTE: IF YOU WISH TO ATTEND A SEMINAR/MEETING BUT DO NOT WISH TO BECOME A MEMBER, SIMPLY COMPLETE THE "MEETING REGISTRATION" FORM FOUND ON THE UPPER LEFT SIDE OF THE HOME PAGE

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