CLC Membership Registration Form

Membership Application and Agreement
Full Name
MM slash DD slash YYYY
Agreement of Membership Dues - Recurring Payments(Required)
Agreement of Cancellation Policy(Required)
Name as it appear on your Credit Card
Credit Card Expiration
Billing Address - if different from your Address listed above
Electronic funds transfer/credit card authorization(Required)
Your signature indicates acceptance of agreements and terms outlined in this membership form