CAA USA Enrollment Children's Adoption Aid USA Enrollment Application Policyholder Information Name * Telephone * Fax Congregation where membership in held * Policyholder Information Address * City * State * AKALARAZCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMDMEMIMNMOMSMTNCNDNENHNJNMNVNYOHOKORPARISCSDTNTXUTVAVTWAWIWVWY Zip * Please mark the plan you wish to enroll in * Plan A - I plan to adopt a child and expect to receive adoptive parent benefits. Cost - $50 per month for a minimum of 30 months. Staff signature is required below for all Plan A applicants. Plan B - I do not plan to adopt a child but wish to contribute on a monthly basis. Cost - $50 per month until I cancel my enrollment. (If you would like to make a one-time donation, please see Information page.) Select payment option * Please send me monthly invoices I wish to be enrolled in the automatic bank withdrawal program. Please send me the necessary enrollment form. Select payment option * Please send me monthly invoices I wish to be enrolled in the automatic bank withdrawal program. Please send me the necessary enrollment form. Staff Approval (Plan A participants only) We have reviewed this application and approve of this couple’s plans to adopt a child and their application for adoption aid. Signature * signature keyboard Clear If you are human, leave this field blank.