2017-2018 KCBA Membership Application KCBA Membership Application Name First Last Firm Name"P" NumberPhoneEmail Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Do you regularly check your email?We use email for notices and Annotations. Yes No Date admitted to Michigan Bar MM DD YYYY BirthdateOptional, but helps identify young lawyers and Senior Seasoned Lawyers. MM DD YYYY YOUR 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 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 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.