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Code of Ethics
Membership App.
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Membership App.

Please print and sign
Fax: 818-700 0538
9772 Cactus Ave.  Chatsworth, CA. 91311


Membership Application
Owner's Name: ________________________________________________
School Name: _________________________________________________
Date Established: ______________________________________________
Address: _____________________________________________________
City: ________________ State: _______________ Zip: _______________
Mailing Address (if different from above): ____________________________
City: ________________ State: _______________ Zip: _______________
E-mail: _______________________________________________________
Website: _____________________________________________________
Telephone: ( _____ ) _______________ Fax: ( _____ ) ________________
Program Offered: _______________________________________________
Legal Status of School:
___ Sole Proprietorship   ___ Partnership  ___ Corporation 
___ Joint Venture  ___ Other : _________________________
___ BPPVE Approved  ___ Voluntary Agreement
Number of Basic And Advanced Graduates:
2006 _____________
2007 _____________
2008 _____________
I confirm that this information is true to the best of my knowledge and can be carifird. I undertstand that CAMSA members are required to maintain the highest standards of professional manner and strictly adhere to its Code of Ethics.
____________________ ______________________ __________________
Print Name                    Signature                          Date



Please print and sign
Fax: 818-700 0538
9772 Cactus Ave.  Chatsworth, CA. 91311