ACA Liaison Transfer Form - American Camp Association

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Membership

Individual

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Camp Accreditation or Affiliation

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Support Camp

Under the terms of membership, individual benefits are transferable ONLY for the ACA Liaison of an ACA-Accredited Camp or ACA Camp Affiliate. The organization can transfer the balance of this ACA Liaison membership to another named person by filling out this form.

Camp

Camp Name		If there is more than one camp to be transferred, please complete a separate form for each camp.
ACA Camp ID #

Former ACA Liaison Information

We must have a forwarding address for the former liaison, otherwise mailings will continue to their former address.

Former ACA Liaison Name
ACA Member ID #
Forwarding Address
City
State
Zip
This address is my:	Home Work
Phone
E-mail
Will this individual remain with the camp listed above? Yes No
If so, please indicate if their ACA membership should continue: Yes No
If ACA Membership is to continue, we will send a renewal invoice. If membership is not to continue, former liaison's membership will lapse immediately.

New ACA Liaison Information

Name
ACA Member ID #

This address is my:	Home Work
Camp/Company Name	(if applicable)
Address
City
State
Zip
Phone
Fax
E-mail	(required)
Onsite Camp Director	(listed on your camp's listing on ACA's Web site)

Public Contact Information

Name
Phone
Fax
E-mail
Web

Form Completed By

Name	(required)
Phone	(required)
E-mail

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