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Membership Application

Please complete this form and contact Heather Lacey for delivery instructions. Make checks payable to Cherished Children API. Please ask us if you need a payment plan – we're quite flexible! Click here to review the Membership Benefits.

_____ Crepido (base or pedestal) Membership: $0.00/year

_____ Necessarius (essential) Membership: $35.00/year ($15 benefits Cherished Children, $20 benefits API)

_____ Potissimus (best of all) Membership: $75.00/year ($15 benefits Cherished Children, $60 benefits API)

_____ Additional Donation to Cherished Children - all amounts over and above your chosen membership level are gratefully accepted and will help sustain your local chapter

Your First and Last Names and Birthdate (year not necessary)
Significant Other's Names and Birthdate (year not necessary)
Names, Birthdates, and Sexes of Children (please include year)
Address
Home Phone
Cell Phone
Work Phone
Email Address
How did you hear about Cherished Children?
What attracted you to this group?
Please tell us if there are any particular AP-related topics you would like us to discuss at future meetings.
What else would you like to share with our group?