California Payphone Association 
General Membership Application
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	Annual Dues Please select one of the following categories:
	____ Voting Members I own ________ installed payphones in California.
	      	 (enter the correct number of phones installed)
	____ Non-Voting Members
	     ____ $500 Industry Supplier	____ $2,500 Silver Industry Supplier
		 ____ $5,000 Gold Industry Supplier  ____ $1,000 Bronze Industry Supplier


	   Date____________    Number of Phones Owned or Managed* in California ___________    
	                       Number of Phones Owned or Managed in Other States___________

Name__________________________________ Company___________________________________________

Address__________________________________________________ P.O. Box_______________________

City__________________________________________________ State____________ Zip_____________

Phone (      )_________________ Fax (      ) __________________ Email ___________________

Payment Type     ____ Visa    ____ M/C     ____ Check Enclosed
 
Card Number ____________--____________--____________--____________ Exp. Date ____________

Cardholder's Name________________________________Signature_______________________________

*When calculating, consider the amount of phones to be the "total number of phones that you own, 
operate, or manage for which you receive dial-around compensation."

 General Voting Membership: 
$.75 per installed phone, per month. ($18 per month minimum, capped at 2,000 phones.)

 Out-of-state vendors, government agencies, installers and affiliated small businesses: 
$500 per year. (Without phones in California)

 Industry Suppliers: $500 per year. 
For greater recognition, the following categories are also available for major industry players: 
GOLD: $5,000; SILVER: $2,500; BRONZE: $1,000.

Members agree to divulge the number of phones owned and/or managed as a condition of continuing membership.
Up-to-date information is essential for accurate billing and planning.

CPA members agree to abide all Bylaws and guidelines set forth by the California Payphone Association.

All categories of membership receive regular industry updates.

I agree to abide by the CPA Bylaws and to remit all applicable dues described above.

Signature_________________________________________ Title_________________________________

We look forward to having you as a member!

Mail or fax completed forms to:
California Payphone Association
1866 Clayton Road, Suite 213, Concord, CA  94520, Phone: (925) 602-5367 Fax: (925) 602-5369