CRIMINAL JUSTICE ASSOCIATION of GEORGIA

Application for Membership

1. Name (Print or type): ________________________________________________________

2. Mailing Address:

3. Affiliation (check one) as faculty ___, student ___, other ___

4. Phone number(s): W: __________________________ H: ___________________________

5. Fax Number: _________________________________________

5. Email address: ________________________________________

By your submission of payment of dues in the amount of ten dollars, $10, and this completed, signed and dated application you are acknowledging your intent to become a member of the Criminal Justice Association of Georgia (CJAG) and to support the objectives of the Association. In the case of students, the dues are five dollars, $5.

________________________________________ Date: ___/ ___/ ______

Signature

Mail this completed form and a check or money order for $10 (or if you are a student, $5) made out to Criminal Justice Association of Georgia to:

Hil Harper, Ph.D.

Department of Sociology/Criminal Justice

Valdosta State University

Valdosta, Georgia   31698

(CJAG Form 1A, 2004)