| Name:_____________________________ | Family Members
To Be Included:____________________ _________________________________ _________________________________ |
| Address:___________________________
____________________________ |
Telephone#:________________________
Email Address:___________________________ |
| Cost is $10.00 per year for individual
or family membership. Please make checks payable to PCKA. |
Mail to: PCKA, c/o Willy Hendrickson
18918 80th Ave Ct E Puyallup, WA 98375 |