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Please copy this form, complete it, and send it along with $30 check to:     

Crime Prevention Association of Michigan
1407 S. Harrison, Suite 333
East Lansing, MI 48823

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Application for Membership

 



Membership Information (will be used for Directory listing) 
Name ___________________________________________________________________________________________


Title ____________________________________________________________________________________________


Organization/Agency ______________________________________________________________________________

Address________________________________________________________________________________________

City__________________________________________________State________________ZIP_________________


Telephone ( ____ ) ________________ Fax ( ____ ) ________________ E-Mail _________________________


Primary area of interest _______________________________________________________________________

Area of Expertise_________________________________________________________________________________

Signature ____________________________________ CPAM is a registered non-profit Michigan corporation

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