Club Member Information Page:

This page is designed so that CICCA Reps or Designated Club Members may submit the information about their club, that they wish to be posted on the CICCA Web Sites Member Page.  Please fill out the form below, and keep your answers brief.

 

Which are you (please choose one)

CICCA Rep Club Member  

Which Club are you reporting on:

 Club Name:
         CICCA Club Number:

What Date Was Your Club Formed:

What Date Did your Club Join CICCA:

When Does your Club Meet (give brief Detail):

       

Enter a brief of any additional information you feel people should know about your club (special events, courses, seminars, or other points of interest):

Tell us how to get in touch with your club:

Rep
E-mail
Tel
FAX
URL
Who is submitting this information:

        Name:

        Email:

Please contact me as soon as possible regarding this matter.

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