Application
$35/Yearly - Cash/Check (payable to CCHEA & mailed to CCHEA Treasurer, P.O. Box 3222 Gulfport, MS 39505)
First & Last Name *
Spouse *
Email *
Primary Phone Number *
Secondary Phone Number *
Street Address *
City *
State *
Zip/Postal Code *
Where does your family attend church? *
Year you started Homeschooling *
Children/DOB *
Please enter Child's first name and Date of Birth
Grade Levels *
Please enter the grade levels that apply to you.
Required
What areas are you willing to serve in? *
Required
Are you currently a member of HSLDA (Home School Legal Defense Association)? *
Membership Qualification *
By completing and submitting this form you agree to the terms and conditions.  You can view these on the Join page.
Required
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