Note:  You cannot fill out and submit this application online.  To use this application, click on the print button on your browser, then fill out the application and send it with your check to the address listed below

Name (s):      ____________________________________________________
Company:     ____________________________________________________
Address:       ____________________________________________________
City, St. Zip:  ____________________________________________________
Phone:          ___________________ FAX  ____________________________

Company: _______________________________________
Address: _______________________________________
City/St/Zip: _______________________________________
Telephone: __________________ Fax: _________________

Name: _____________________ Title: _________________
Email: ___________________________________________

Name: _____________________ Title: _________________
Email: ___________________________________________

Name: _____________________ Title: _________________
Email: ___________________________________________

Name: _____________________ Title: _________________
Email: ___________________________________________

Name: _____________________ Title: _________________
Email: ___________________________________________

Please include your Email address and receive monthly web site update notices
Annual Dues: $50 for individuals, and just $200 for company membership (up to five un-named individuals).

Annual Dues: $50.00 - Individual Membership $200.00 - Corporate Membership (up to 5 persons) (up to five people will receive a free copy of the monthly 50Sacramento Claims Association News Network). Members Enjoy: - A free copy of the monthly Sacramento Claims Association News Network newsletter. - Discounted Lunch rates - Annual Golf Tournament Priority - Seminars & Continuing Education - Pride in Industry Involvement

Corporate Membership Individual Membership Annual dues are $50.00 per person. Company Memberships $200.00 Total Amount Enclosed: $ ________ Complete and mail your membership application, with check made payable to SCA, to: Barbara Prosch c/o El Dorado Restoration P.O. Box 3070 Diamond Springs, CA 95619 530-626-1676 email: barbarap@eldoradorestoration.com

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