Membership

Membership Application Form

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Secondary Phone Number *

Email *

Membership Type *

If you selected a family membership, please state the names of the family members *

Would you like to be be recognized publicly as a CPT member? If so, your name will appear in the annual report and in occasional CPT marketing material. *

Yes. I wish to be recognized publicly. No thank you.

Name you would prefer for recognition *

Would you like to be a voting member? *

Yes, I am 18 years of age or older and want to be a voting member No, I do not wish to be a voting member

To qualify as a voting member please choose a category *

If you selected 'Other', please explain. Otherwise type 'N/A' *

I have read and agree to the Children's Peace Theatre Membership terms of service *

I agree

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