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Membership Form...

You may print or fax the following form to the executive office to become a member (if you are currently a guest) or you may send it to a collogue for them to become a member :
The form is also available for download (here)

CPPC
P.O. Box 1117
Newburgh, IN 47629.
Questions?  Call us at (866) 276-5656

FAX: (812) 858-0599

e-mail us

CONTACT NAME:
COMPANY NAME:
MAILING ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
FAX:
E-MAIL:
INTERNET ADDRESS:
GEOGRAPHICAL AREA YOU SERVICE:

 

FIRST 3 DIGITS OF ZIP CODES IN WHICH YOU PROVIDE SERVICE: ...*** (Note: Zip codes can only be within in the state of your address listing. Zip codes in another state must be listed through a branch listing.)

 

 

DESCRIPTION OF YOUR SERVICES:

 

 

 

 If referred by a current CPPC member, please name: