Partners for Justice Membership Form

SECTION 1: Member Information

TITLE	Mr.           Mrs.           Miss           Ms.           Dr.           Other, specify:
FULL NAME
ADDRESS		PHONE #
CITY/ZIP	--- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	WORK	( )
EMAIL		CELL	( )
COMPANY		COMPANY	( )

SECTION 2: Membership Type and Payment Details

MEMBER TYPE	DESCRIPTION	ANNUAL MEMBERSHIP DUES	PLEASE CHECK
GENERAL	Partners for Justice  - General Membership *	$50
CLASSIC	Partners for Justice  - Classic Membership **	$100
PREMIUM	Partners for Justice  - Premium Membership ***	$250 or more
PAYMENT METHOD	Cash        Check    Online  www.legalservicesalabama.org	Make checks payable to: Legal Services Alabama

*General Members receive 2 hours free CLE, certificate, recognition in Annual Report

**Classic Members receive 2 hours free CLE, certificate, access to AlabamaProBono.org, recognition in Annual Report

***Premium Members receive 2 hours free CLE, certificate, access to AlabamaProBono.org, recognition in Annual Report, appreciation gift

If you have questions, please contact Debra Hansen, Director of Resource Development, at dhansen@alsp.org