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Name

First name *

Last name *

Initial

Spouse Name

First name *

Last name *

Initial

Email address *

Phone number

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Age *

Address

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Street *

City *

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Name of children

Sex

Name of children

Sex

Name of children

Sex

Please check on box for your membership selection

Life Time Memebership	Single	$50.00
Life Time Memebership	Family	$100.00
Regular / Yearly Memebership	Single	$15.00
Regular / Yearly Memebership	Family	$25.00

I/We request the ICAA to accept Me/Us as member/members. I/We are eligible for membership in the association as per the constitution of the association and promise to abide by the rules and regulations of the Association.