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Membership Application

I hereby make application for membership in the Washington State Jail Association in accordance with its constitution and bylaws.

Classification – Please check one
  1. $15.00____Full time / Line Level Staff
  2. $15.00____Full time / Line Level Supervisor
  3. $15.00____Manager / Small Jail or W/R
  4. $15.00____Manager / Large Jail or W/R
  5. $10.00____Group Membership *
  6. $10.00____Associate / Interested Party
Remit To
Dee Anna Zavodny
WSJA/Data Processor
28 SW Chehalis Ave.
Chehalis, WA, 98531
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*NOTE: Membership is subject to payment of dues.

Voting is limited to membership classifications 1-5

To qualify for group membership contact Data Processor.

Verification Of Employment: Must be signed by supervisor or above. I hereby certify that the information supplied is true and correct. (not needed on renewal)

X________________Title_______________

 

Please Print Legibly

Name:
Department:
Dept. Address:
City/State/Zip:
Home Address:
City/State/Zip:
Work Phone: E-Mail
Home Phone: E-Mail
Position/Title:
Date Of Birth:
Sign And Date:

 

 

We can’t speak for you if we don’t hear from you. Send it today!!!