Certification
(Required ONLY if applying for Active Membership)
As the Coroner or Medical Examiner of County in the State of California, I hereby certify the above applicant meets the requirements for Active Membership in the California State Coroners’ Association.
Date:
Name:
Title:
Sign: ______________________________________
Fill out the form, Print The Form, (don’t forget to sign it), then mail it with check payable to CSCA to:
Robert Foucrault, CSCA EXECUTIVE DIRECTOR, 211 Bradbury Lane, Redwood City, CA 94061
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