Industry Membership Application

Industry Membership Application

Please provide the following contact information:
First Name*Last Name*
Title
Company*
Work Address*
City*State*
ZipCode*
Phone*Phone Ext.
FAX
Email*
Website
SafeHuman
You must join CSNA and at least one chapter
CSNA $160 Per Individual includes first two chapters.(Company membership not available)
Southern (SCSNA #01) $30
Northern (NCSNA #02) $30
Central (CCSNA #10) $30
Far North (FNCSNA #20) $30
Mother Lode #45 $30
Total 
Payment Type: Credit Card Type:
Credit Card Holder's First Name:
Credit Card Holder's Last Name:
Credit Card #:
Credit Card Expiration Date:  
CC V-Code:
CC Street Address:
CC Zip:

(We cannot process purchase orders.)

Comments:


California School Nutrition Association
PO Box 11376, Burbank, California 91510
Phone: (818) 842-3040 | Fax: (818) 843-7423
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