Renewal Form
    Member Information
  1. Please enter your name, email address, and select your membership type.

    All other fields are optional - please only enter the fields which have changed.

    If you would prefer, you can also mail your check to CCPAS, 2100 Tice Valley Blvd, Walnut Creek, CA 94595

    Note : These fields are required: (*)
  2. First Name:(*)
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  3. Last Name(*)
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  4. Email address(*)
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  5. The following entries are only required if they have changed from those in the Directory.

  6. Name of Organization/Firm (if applicable)
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  7. Street Address
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  8. Apt #
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  9. City
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  10. State
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  11. Zip
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  12. Home phone
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  13. Cell phone
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  14. Do you want to be listed in the Directory?
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  15. Receive newsletter by
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  16. Sending the newsletter by email saves PAS printing and mailing costs. Your email address is used only for sending the monthly newsletter and critical event updates - your privacy is important to us.
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  18. Please select up to 4 musical interests :
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  20. Please select your primary instrument(s). (Up to three may be selected ).
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  24. Voice Range:
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  28. Second Family Member
  29. First Name:
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  30. Last Name:
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  31. Cell phone:
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  32. Email address:
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  33. Invalid Input
  34. Please select up to 4 musical interests :
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  36. Please select this family member's primary instrument(s). (Up to three may be selected ).
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  40. Voice Range
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  41. Third Family Member
  42. First Name:
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  43. Last Name:
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  44. Cell phone:
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  45. Email address:
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  46. Invalid Input
  47. Please select up to 4 musical interests :
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  48. Invalid Input
  49. Please select this family member's primary instrument(s). (Up to three may be selected ).
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  53. Voice Range
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  54. Fourth Family Member
  55. First Name:
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  56. Last Name:
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  57. Cell phone:
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  58. Email address:
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  59. Invalid Input
  60. Please select up to 4 musical interests :
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  61. Invalid Input
  62. Please select this family member's primary instrument(s). (Up to three may be selected ).
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  63. Invalid Input
  64. Invalid Input
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  66. Voice Range
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  67. CCPAS Membership Type(*)
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  68. Optional tax-deductible donation
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  69. Total
    0.00