2017-2018 KCBA Membership ApplicationKCBA Membership Application Name First Last Firm Name"P" NumberPhoneEmail Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Do you regularly check your email?We use email for notices and Annotations. Yes NoDate admitted to Michigan Bar MM DD YYYYBirthdateOptional, but helps identify young lawyers and Senior Seasoned Lawyers. MM DD YYYYYOUR area(s) of practice:Please check below if you can volunteer on any of these committees: Nominating for the KCBA Board of Directors Pro Bono Clinics (Law Library, PCOC, Powell Library, Eastside Neighborhood Association) KCBA Golf Outing Budget & Finance of KCBA Board Probate (Gull Road Courthouse)Practice AreasPlease indicate if you would like to be included or join: Family Law Bar (all Family Court practitioners) Charles A. Pratt Bar Association Trial Lawyers Young Lawyers (less than 36 years of age)Please select option most applicable to youLess than one year of practice - $00.001 to 5 years of practice - $75.00Over 5 years of practice - $110.0070 years of age or older - $0.00SuggestionsThe KCBA Board wants to hear from you. Please give us your input on the following:Are you interested in attending education programs? Please indicate areas of law or topics that are of interest to you/your firm.Are you interested in participating in service projects as a KCBA member?Are you interested in any new social events as a KCBA member? If so, what do you suggest?What else can the KCBA do to serve you better?What other thoughts or suggestions do you have to add?Credit Card Processing Fee Price: $0.00 Total Due: $0.00 American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Annual dues are payable on or before July 1st. Dues are not deductible as charitable contributions but may be deductible as ordinary and necessary business expenses. Please consider a donation to the KCBA Endowment Fund, a 501(c)(3) organization to help fund local law related programs. To donate, send a separate check payable to: "KCBA Endowment Fund". This iframe contains the logic required to handle Ajax powered Gravity Forms.