Membership Application

NOTE: * implies that the information in this field is required

Membership Type:
Yearly Membership ($225.00)
Lifetime Membership ($3200.00)
Senior Status ($75.00)

Prefix
First Name * Middle Name Last Name *
Suffix Title
District/DOJ (click here to add multiple entries)
Former US Attorney: * yes no

Appointed by *:

District *:

DOJ Title *:

Year From *:

Year To *:

Presidential Administration *
Email Address *
Spouse's Name
Education (click here to add multiple entries. MAX: 250 chars each.)
Practice Area(s) (click here to add multiple entries. MAX: 250 chars each.)
Publication(s) (click here to add multiple entries. MAX: 250 chars each.)
Other Public Office(s) (click here to add multiple entries. MAX: 250 chars each.)
Contact Information (click here to add multiple entries)
NOTE: If you select the contact type "Personal (Confidential)", your contact information will not be listed publicly on the NAFUSA website. All other contact types will be listed publicly on the NAFUSA website.
Type:

Name:

Address 1:

Address 2:

Address 3:

Address 4:

City: State:

Zip Code: Country:

Phone: Fax:

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