| To be a voting member of CCIC, you or your organization
must pay appropriate dues or have received a waiver of dues from the Board
of Directors.
Requests for waiver of dues should be sent to the Board of Directors
c/o the CCIC office.
- Individual membership dues are $25. -
Organizational membership dues are $100.
Please fill out the following form and return to:
Colorado Children's Immunization Coalition
1056 E. 19th Avenue B281
Denver, CO. 80218
(303) 864-5340
Fax (303) 861-6963
Or email the following information here.
Thank you!
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NAME___________________________________________
ORGANIZATION__________________________________
If Organizational -List Names of Members to be included________________________________________
________________________________________________
Name of Voting Member
________________________________________________
Type of Membership_____________________________
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