Family Access Membership Application

Family Access Membership Application

Please complete your application here and then submit a copy of one of the verification documents listed below under Proof of Eligibility, by email to members@cmosc.org

Note: Once approved, the membership fee is due within 2 weeks.

Primary Adult *
Primary Adult
Address *
Address
Cell Phone *
Cell Phone
Partner/Spouse
Partner/Spouse
Dependent Child 1
Dependent Child 1
Date of Birth
Date of Birth
Dependent Child 2
Dependent Child 2
Date or Birth
Date or Birth
Dependent Child 3
Dependent Child 3
Date of Birth
Date of Birth
Dependent Child 4
Dependent Child 4
Date of Birth
Date of Birth

What is your ethnicity?

Proof of Eligibility *
This 1-year reduced-cost membership is available to families currently receiving assistance from a government or social service organization. Check all programs you currently participate in.

Please submit a copy of ONE document listed below, dated within the last 2 months, as proof of eligibility to members@cmosc.org.

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