membership application - Tulare County County Child Abuse Prevention Council

Join CAPC

Become a Member

CAPC Membership Article Sheet 24-25_Page_1

download form

CAPC Membership Application

Name

First Last

Title

Application Status(Required)

Affiliation(Required)

Agency/Individual Name

Website of Agency

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Work Phone

Cell Phone

Fax

Email(Required)

Membership on Other Boards/Commissions

In applying for an Organizational membership I have authority, as granted by___________________(name& title) to represent

Would you be interested in participating in the Cynthia Lockhart Mummery Conference planning?

As a member of CAPC, I understand that I may not have more than three unexcused absences per calendar year to maintain membership & I agree to participate by representing myself or agency in the Council’s activities and decisions, as stated in the Council By-Laws : “A Council Member must show involvement in and support from the organizations, agencies, and constituencies they represent & be willing to be a liaison between them and the Council.

Signature(Required)

Signature

Date(Required)

Attend CAPC Meetings

Meeting Dates For 2024-2025

August 22
October 24
November 4 -CLM Conference
January 23
March 27
May 22

See Calendar For Locations/Times