APPLICATION FOR MEMBERSHIP IN THE MACOMB COUNTY PROBATE BAR ASSOCIATION

I hereby make application for membership in the Macomb County Probate Bar Association and, if accepted, agree to abide by the By-Laws and Constitution thereof. I further understand and agree to the payment of membership dues at the rate of $50.00 per year, which shall be payable upon submission of this application. I am a member in good standing of the State Bar of Michigan.

Name of Applicant: ____________________________________________________

Address: (Work) _______________________________________________________

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Telephone: ____________________________________________________________

Facsimile: ____________________________________________________________

Address: (Home) _______________________________________________________

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Telephone: (Home) _____________________________________________________

Email Address: ________________________________________________________

Website: ______________________________________________________________

Date of Birth: ________________________________________________________

Date Licensed to Practice in the State of Michigan: ___________________

State Bar of Michigan Membership Number: ______________________________

Release information to MCPBA website member directory?   Yes   No

Date: ___________   Signature _________________________________________

Please return completed application with check in the amount of $50.00 made payable to MACOMB COUNTY PROBATE BAR ASSOCIATION and mail to:

PJ Tomlian / MCPBA Administrative Assistant
77017 Omo Road
Armada, MI 48005