MARIN CHAPTER – CALIFORNIA GRAND JURORS’ ASSOCIATION
P.O. Box 4274, San Rafael, CA 94913-427
MEMBERSHIP APPLICATION (rev 5/28/18)
Jurors impaneled as the 2017-2018 Civil Grand Jury, may use this application.
Jurors who have served on a Marin County Civil Grand Jury have organized as the Marin Chapter of the California Grand Jurors’ Association (CGJA), a California Nonprofit Public Benefit Corporation designated an IRS Section 501(C) (3) Tax Exempt Corporation.
The Marin Chapter provides an organizational structure within which you may donate your time, your energy, and your expertise to the support of the Civil Grand Jury program in Marin County. Members of the Marin Chapter have served on one or more Civil Grand Juries and continue to contribute to governance in Marin County by engaging as private citizens in pursuing and influencing the implementation of report recommendations.
. The dues structure is: one year dues, $30; multi-year dues, $25/year (for each of the number of years selected), $300 in total dues (if paid over an extended number of years) and Life member dues are a one-time payment of $180.
Indicate your choice: One year ______, Multiple year (the number of years) ________, Life membership ________. Enclosed is a check in the amount of __________ , payable to MC-CGJA. Please mail the check and this application to: Marin Chapter, CGJA, P.O. Box 4274, San Rafael, CA 94913-4274. Attn: Treasurer.
We need the following contact information: (Please print legiblyor apply a return address label)
Name _____________________________________________________________ Date _________________
Mailing Address ____________________________________________________________________________
City _________________________ Zip Code ______________Contact phone # _____________________
(Please print legibly)_______________________________________________________________________
California County(s) in which you served on a Regular Grand Jury ___________________________________
The years of Regular Grand Jury Service (e.g. 2010-2011 or after) __________________________________
We work very hard to protect the personal contact information provided above. We promise that neither this organization nor its officials, will knowingly provide, sell, trade, transfer or in any other way deliberately reveal any such private member information to any party outside of the California Grand Jurors’ Association.
We welcome your application,
Tom Borden, President, Marin Chapter of the California Grand Jurors’ Association
Nadine Muller, Membership Chair
Mobile Phone: 415-203-0929 Email: firstname.lastname@example.org.
Mail application to: Marin Chapter, CGJA, P.O. Box 4274, San Rafael, CA 94913-4274. Attn: Treasurer.
You can fill out this application and email it to our email account: email@example.com
(You do not need to have an account with PayPal- you can pay with a debit or credit card)