Please print this form, fill it out completely,
then mail it to the AACCA registration office.
Contact Name: _______________________________________________
Home Address: _______________________________________________
City/State/Zip: _______________________________________________
Home Phone: (______) ______-________
Cell Phone: (______) ______-________
Email address: _______________________________________________
School/Organization: _______________________________________________
Address: _______________________________________________
(NOTE: Can NOT ship to a P.O. box)
City/State/Zip: _______________________________________________
School Phone: (______) ______-________
Fax Number: (______) ______-________
One Year AACCA Membership
$10.00 $ ________
AACCA Cheerleading Safety Manual
$25.00 ($20.00 + $5.00 s&h) $ ________
FedEx Shipping
add $10 $ ________
Make check payable to AACCA and mail this form and fees to:
AACCA Office
6745 Lenox Center Court, Suite 300
Memphis, TN 38115
OR fax with credit card info to 901-251-5851
Attn: Terri Blocker-Johnson
Credit Card #: _________________________________________
Credit Card Type: ______________ Exp: ____ / _______
Signature: _________________________________________
**If you are using a Purchase Order, an original School Purchase Order must be submitted along with this form.
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