Membership Form

Important note: This years MCA conference dates March 30 - April 1, 2009

Membership Form

MCA MEMBERSHIP FORM

Washington State Misdemeanant Corrections Association Membership

Professional Member ($25.00) q Renewal q New

Associate Member ($10.00) q Renewal q New

Date: ____________________________________________

MCA Tax ID# 91-1254334

First Name
Last Name
Title
Organization
Street Address
Address (cont)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
Email
MCA Interests		q Legislative q Membership q Education q Newsletter
Will you be reimbursed by public funds?		q Yes q No
Number of years in probation
Member of MCA since

Membership is good for one year in the calendar year that it is paid.

Text Box: Example:
If you pay in January of 2009 your membership is valid until December 31, 2009.
If you pay in November of 2009, your membership is valid until December 31, 2009

Please fill out form, include a check payable to MCA and mail to:

Linda Eiford, Treasurer

Skagit County District Court Probation

RM 301 County Courthouse

205 West Kincaid

Mount Vernon, WA 98273

Last modified: 12/19/08