Mexican American Correctional Association

Designed and Hosted by

To Join

Membership Application

New Member Transfer Renewal

Address Change Current Member Other

Last Name
First Name		Middle Initial
Department / Agency		Title
Employed At (Facility)		Home Telephone
Home Address		Zip Code
City, State		E-mail
Chapter		Recruited By:

Please Check Apppropriate Box

State Employees: Please put me on Payroll Deduction

Los Angeles County: Please put me on Payroll Deduction

San Diego County: Please put me on Payroll Deduction

Other :

pay my dues directly.

Enclosed is my check for ($108.00 or $54.00) to pay for (12 months or 6 months) of membership dues.

I hereby authorize the Mexican American Correctional Association to deduct from my salary and transmit as designated an amount for membership dues and any benefit program for which I have applied which is sponsored by the above organization. I certify I am a member of the aforementioned organization and understand that termination of membership will cancel all deductions made under this authorization.

Please Print and Mail to:

Signature _________________________________________ Date ____________

P.O. Box 221008, Sacramento, CA 95822

Rev. 2/03