Agency Name:

Representative:

Title of Representative:

Mailing Address (include city, state & zip code):

Phone:

Fax:

E-mail:

Number of School Board Members:

	1- Riverside & San Bernadino		10- Contra Costa, Napa, Solano
	2- Orange County		12- Kern County
	3- San Diego & Imperial		13- Sonoma, Marin, Lake, Mendocino
	4- Los Angeles		14- King, Tulare, Inyo
	5- Ventura & Santa Barbara		15- North San Joaquin Valley
	6- Sacramento Area		17- Redding, Shasta, Wonderland
	7- San Francisco Bay Area		18- Humboldt, Del Norte
	8- Fresno & Central Valley		19- Monterey, Santa Cruz, San Benito
	9- San Luis Obispo & Central Coast		20- High Desert

YES! Please enroll me as a CASTO member for the coming year (July 1 through June 30). I have checked the appropriate dues category and indicated my desired method of payment

AMOUNT OF DUES:
$150 - Agency Member

CREDIT CARD INFORMATION:
VISA
Mastercard

Name as it appears on the card:

Billing Address (include city, state & zip code):

Card Number:

V-number (back of card, last group of numbers on signature line):

Expiration Date: