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Business Name: ________________________________________________________   Title (Owner, Manager,Tech): ______________

Street Address: _____________________________________________________________

City: _________________________________ State: _____________ Zip____________________

Phone:_________________________________ Fax:__________________________________

Web Site URL _____________________________________________________________

E-Mail:____________________________________________________________________

Sponsored By:______________________________________________________________
                              If no sponsor, leave blank and a CCRE representative will contact you.

• ____ Collision Shop Owner Sponsor   $ 365.00
• ____  PRI-IVE (Post Repair Inspectors, Independent Vehicle Examiners)  $300.00
• ____ T-E (Technician or Employees of collision repair facilities   $125.00
• ____ Affiliate Sponsor  Bronze $1,000.00, Silver $1,500.00, Gold $ 2,500.00 Platinum any amount over $2,500.00 Trade Associations,Auto Manufacturers,    Equipment Manufacturers, trade publications,  Investigative or legal professionals. Newsletter recognition included at option of Affiliate Sponsor.
• All membership prices are for annual dues, based on a full payment.  Optional payment plans are available upon request. All applications and applicants are subject to Board approval.

• Mail payment and application to:                                                       CCRE Limited
                                                                                                              PO Box 71
                                                                                                   Spring City, PA. 19475-0071
                                                                         Phone toll free 877-700-7743 Fax toll free 877-700-7747

                                                                                      website: www.theccre.com or Email:office@theccre.com

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