Membership Application

(Print this form, fill it out, and mail it to the address at the bottom of this page)
NABCJ CENTRAL OKLAHOMA CHAPTER Membership Application
[ ] Mr. [ ] Mrs. [ ] Ms. [ ] Dr.	Date:
Last Name:	First Name:
Address:
City, State & ZIP:
Title:	Agency:
Employment Address:
City:
State:	ZIP Code:
Work Phone:	Home Phone:
FAX:	Send Correspondence to: [ ] Home [ ] Work
Type of Application: [ ] New [ ] Renewal
Type of Membership: [ ] Central Oklahoma Chapter: $35.00 [ ] National: $50.00 [ ] Student: $15.00 [ ] Agency: $300.00 [ ] Lifetime: $750.00
Professional Interests:
[ ] Law Enforcement Administration	[ ] Institution-Based Corrections Support Services
[ ] Community-Based Corrections	[ ] Criminal Justice Education & Training
[ ] Judicial	[ ] Individual/Family
[ ] Juvenile Justice	[ ] Other:
Questionnaire:
1. Are you currently employed by a [ ] Federal Agency [ ] State Agency [ ] Local Agency [ ] Private Sector [ ] Other (specify):
2. Are you employed in the criminal justice field? [ ] Yes [ ] No
3. Are you a member of ACA? [ ] Yes [ ] No
4. Have you attended a NABCJ National Conference? [ ] Yes If yes, what year? [ ] No
Please return this completed application and check payable to NABCJ to: Lenora A. Hudson P.O. Box 11821 Oklahoma City, OK 73136