MISSISSIPPI 911 COORDINATORS ASSOCIATION, INC. 2023-2024 MEMBERSHIP APPLICATION

MISSISSIPPI 911 COORDINATORS ASSOCIATION, INC. 2023-2024 MEMBERSHIP APPLICATION
FIRST AND LAST NAME*
TITLE*
AGENCY*
MAILING ADDRESS*
CITY*
ZIP*
E-MAIL ADDRESS*
example@example.com
OFFICE PHONE*
FAX*
TYPE OF MEMBERSHIP REQUESTED: (Please select one)*

CORPORATE............................................................................ $300SINGLE..................................................................................... $50
(Voting members, being persons employed by a PSAP, 9-1-1 Commission, 9-1-1 Office, etc.)
By my signature I hereby apply for membership in the Mississippi 9-1-1 Coordinators Association, and agree to abide by the constitution and Bylaws of the Association. I understand that by joining, my dues are payable annually beginning July 1st and must be received by November 30th to be considered a voting member.
SIGNATURE*

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Date
Please make check payable to:

Mississippi 911 Coordinators Association

P.O. Box 5091 Holly Springs, MS 38634

(The address has changed, please be sure your administrative or accounting department is aware of this change.)

Payments may also be received by credit card which will result in additional fees for processing. For more information contact Cathy Hannah, Treasurer at cathy@ms911 coordinators.org
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