Individual Memberships
__ Limited Income:
$10
__ For
individuals: $30
__ Supporter:
$250
__ Sustainer:
$500
For non-profits & corporations
__ Bronze Sponsor:
$100
__ Silver Sponsor:
$250
__ Gold Sponsor:
$500
__ Other:
>$500*
Member Info
Name: ______________________
Company Name (optional): _____________
Address: ________________________
________________________
Phone: _________________________
Email: _________________________
Make check payable to CCBA and mail to:
CCBA
P.O.
Box 270149
West
Hartford, CT 06127-0149