Membership Application

Arkansas District and City Court Clerks Association

Membership Application

Membership is open to anyone serving as a chief clerk or deputy clerk in an Arkansas district or city court. Dues: $25.00 per year for each clerk wishing to join the Association

Make your checks payable to: Arkansas District and City Court Clerks Association

Mail payment and membership application to the current Association Treasurer .

Please include a self-addressed stamped envelope so that a receipt and membership card can be mailed back to you.

Application

Name :_________________________________________________

Name of Court: __________________________________________

Court Location: City _________________ County: ________________

Title: (please circle one) Chief Clerk Deputy Clerk

Hire Date: (as chief clerk or deputy clerk) ________________________

Address :_______________________________________________

City: _______________________ State: Arkansas Zip Code : ______

Telephone: ___________________ Fax :______________________

e-mail address: __________________________________________

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