Chapter Membership Form

Membership Information

Your First Name:

Your Last Name:

Address:

City: State: Zip:

Phone: (work) Phone: (home)

Fax:

Your Email:

Race: (optional)

Your Profession

Which best describes your professional status?
 AttorneyAlumna/us of:  Legal Worker  Law Student Attending:
 Jailhouse Lawyer

Type of Employment:
 Private Practice Government Agency Labor Union Legal Services Public Defender Law Professor Judge Other

Payment

Membership dues are based on income levels, and may be paid in quarterly installments. No one will be denied membership because of inability to pay. Members of minority legal organizations may pay half the dues indicated below.

Law Students = $25
Jailhouse Lawyers = Free
Lawyers and Legal Workers
Under $15,000 = $40
$15,000 - 20,000 = $50
$20,000 - 25,000 = $75
$25,001 - 30,000 = $100
$30,001 - 40,000 = $150
$40,001 - 50,000 = $200
$50,001 - 60,000 = $250
$60,001 - 70,000 = $300
$70,001 - 80,000 = $350
$80,001 - 90,000 = $400
$90,001 - 100,000 = $450
Over $100,000 = $500

*Please consider subsidizing a Mass Dissent subscription for $20 for one of over 60 jailhouse lawyers who receive free Chapter membership.

Membership Dues - $
*Subscription Subsidy (+ $20)
Total Membership Due: - $

I will make this payment  online Guild Circle (monthly automatic withdrawals) mail a check

Membership Participation

I would like to participate in the work of:
 Mass Dissent Committee Testimonial Dinner Committee Fundraising Committee Workers' Rights Clinic Tenant/Landlord Dispute Clinic Stop & Search Clinic Civil Disobedience Support Group Lawyer Referral Service National Immigration Project Other

I am interested in organizing Guild work on the following issues:
 International Issues Prisoners' Rights Labor Support Police Misconduct Human and Civil Rights Death Penalty  Health & Environment Housing Other
 I can help with mailing and office work