Membership Form-TSP

Three Shakthi Pitam Membership Application

National Membership of Three Shakthi Pitam Chityal, Kaddam Peddur, Nirmal Dist, Hyderabad,Telangana, INDIA-504202
Title*

Mr.Mrs.Ms.Dr.
Name*

First NameLast NameSuffix
Father Name

First NameLast Name
Mother Name

First NameLast Name
Address:*

H.No

Village, Mandal, Taluqa

DistrictState / Province

Postal / Zip CodeCountry
Mobile Number:

Phone Number
E-mail*
example@example.com
Birth Date:

MonthDayYear
Date of Birth:

MonthDayYear
Date
Are you a student?*

YesNo
*Undergraduate Students Applying for Membership must be enrolled full-time (12 credit hours per semester) Graduate Students (9 Credit hours per semester) and cannot be employed full –time to qualify for Student Membership. A student must send proof of current enrollment by submitting an unofficial transcript, or a copy of their registration receipt. Membership will not be processed without verification.
What College or University?*
Major
Expected Graduation Year?
Are you employed by:*

Federal AgencyState AgencyLocal AgencyPrivate - For ProfitPrivate - Non-Profit
Position of Employment
Professional Interest

Law EnforcementJudicial AdministrationJuvenile JusticeInstitution-Based CorrectionsCommunity-Based CorrectionsIndividual Family SupportCriminal Justice Education and TrainingOther
Are you a member of a TSP Chapter?*

YesNo
Which Chapter?
Type of Application*

NewRenewal
Membership Number
Have you attended a TSP Conference?

YesNo
When did you last attend a TSP Conference?
How will you be submitting payment?*

Credit CardCheck by Mail (fill out the form after submission and mail)
I have read, understood, and accepted the rules for membership.
Signature

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Once you submit your application, you will receive a confirmation email and be taken to purchase your registrations at shop.nabcj.org.

Thank you!
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Three Shakthi Pitam Membership Application