COSA Membership Form for 2021
COSA membership is valid for our fiscal year July 1, 2020 through June 30, 2021.
If you have any questions, please contact COSA at COSAhc@gmail.com. Thank you!
Email *
First name *
Last name *
Organization Name (or Your Name for Individual Membership) *
This is how you or your organization will be listed in the newsletter and on the COSA website.
Website:
COSA will link to this address in the newsletter and on the COSA website.
Membership Category: *
Membership support is based on your organization's TOTAL annual budget.
Does your organization need an invoice to process this payment? *
COSA will email an invoice at your request.
Please make checks payable to COSA. Federal ID# 04-3233858.
COSA's mailing address is: PO Box 343, Amherst, MA 01004.
Mailing Address: *
Please include your PO Box/Street, City, State, Zip Code.
Do you give COSA permission to add your email to our mailing list? *
COSA regularly emails a newsletter and occasional announcements. We do not sell or share our mailing list.
A copy of your responses will be emailed to the address you provided.
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