CRCAA Membership Form
Thank you for becoming a member of the Cody Rouge Community Action Alliance CDC!

We will send you a confirmation email after we process your form. If you have any questions, please email: rbare@codyrouge.org 
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Your first and last name *
Age range *
Other adults in household? If yes, please include name and age range.
Address, City, State, ZIP *
Phone number *
E-mail address *
Are there children in the household? If yes, please include names and ages.
Race/ethnicity (CRCAA is open to people of all backgrounds and does not discriminate. However, many of our programs are asked to report this data anonymously as part of their funding requirements.) *
Affiliation to Cody Rouge *
Are you interested in volunteering? *
If interested in volunteering, what types of projects?
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