New Member Application

AMCCMA Form 1

Rev. June 2009

ALABAMA MUNICIPAL COURT CLERKS and MAGISTRATES ASSOCIATION

NEW MEMBER APPLICATION and INFORMATION FORM

2018 ANNUAL MEMBERSHIP DUES $100.00

Name

Municipal Court

Address

Phone

For questions concerning memberships call Joy Evans at 334.782.2201 and leave a number where you can be reached after 5 pm or email your questions to jevans1561@charter.net.

Make Check(s) Payable To: AMCCMA

Mail Form(s) and Check(s) To: AMCCMA

PO Box 3585

Montgomery, AL 36109

FOR OFFICE USE ONLY – DO NOT WRITE IN THIS BLOCK

Check Number________________________________________________

Check Amount $______________________________________________

Deposit Date 20______________________________________________

Member ID# __________________________________________________

∘ Mailed Member Pin

∘ Mailed Certified Rocker (if applicable)