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2019-2020 MEMBERSHIP APPLICATION

September 1, 2019 – August 31, 2020

TYPE OF MEMBERSHIP (see descriptions below form) *
Current Total:
$0.00
 *
Secured by Formsite

(Your name, title, address, telephone, e-mail, and area of practice may be included in a membership directory).

CONSENT AND RELEASE: By paying membership to the National Black Prosecutors Association (NBPA), the applicant hereby grants permission to the National Black Prosecutors Association and its affiliates and agents (NBPA) to take, use, modify, reproduce or publish his/her appearance or likeness by means of photographic equipment, photographs, or other techniques and/or media (including but not limited to brochures, calendars, and other promotional materials), and to use his/her name (at NBPA’s option) in any printed matter, which contains his/her appearance or likeness. The undersigned hereby disclaims any and all copyrights in such works.

Checks should be made payable to: National Black Prosecutors Association

Mailing Address: 1507 East 53rd Street, Suite 108 Chicago, IL 60615 or www.blackprosecutors.org
For membership questions, please email: membershipblackprosecutorsorg@gmail.com