Join CAPA

What would you like to do

New Membership

Membership Renewal

Information Change

The information requested on this form is for use by CAPA State Board and Chapter officers to notify members of meetings and educational opportunities (annual NAP Day workshop, CAPA conference and other CAPA sponsored workshops as they become available). Information also will be published on the members’ only section of the CAPA website www.thecapa.org.

I prefer that the address of the facility where I work be used as my primary address instead of my personal home address and I am aware if I change jobs my mail will probably will not be forwarded

Last Name (Required)

First Name (Required)

Personal/Home Address (including street, bldg. and suite/apt #) (Required)

City (Required)

State (Required)

Zip Code (Required)

Home Phone (Required)

Cell Phone (Required)

Personal E-mail (Required)

Facility (Required)

Facility Address (including street, bldg. and suite/apt #)

Facility City

Facility State

Facility Zip Code

Work Phone

Work Cell

Work Fax

Work Email

Job Title

Certification

Membership Type

INDIVIDUAL $50.00 (actively working in health care profession)

STUDENT $20.00 (must be enrolled in a accredited online Activity Professional study course)

ALUMNI $35.00 (retired from the activity profession but supportive of the field)

Payment Type (Required)

Personal Check

Company Check

Credit Card (PayPal)

Make checks payable to CAPA and mail to:

Breanna Isringhausen, AAP-BC
1800 Main St Apt A1
Grand Junction CO 81501

Chapter (Required)

As a CAPA member what SEB and/or Chapter positions do you hold?

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PO BOX 62524
Colorado Springs, CO
80962-2524

Membership Questions?
Breanna Isringhausen
719-248-5846
breisringhausen@outlook.com