2004 Membership Application
1. Last Name First Initial
2. Title Birthday
3. Municipality or Agency
4. Business Address Zip
5.
6. Business Telephone Fax Number
7. E-mail Address
8. Spouse’s/Partner’s Name
9. Home Address Zip
10. Home Telephone
11. Were you a member of the Michigan Local Government Management Association last year? ¨ Yes ¨ No
12. Are you a voting member of ICMA? ¨ Yes ¨ No
13. Race (voluntary): ¨ White/Non-Hispanic ¨ Black/Non-Hispanic ¨ Hispanic
¨ Asian/Pacific Islander ¨ American Indian/Alaskan Native
14. Sex (voluntary): ¨ Male ¨ Female
15. I am applying for membership in the following category. Categories and dues are explained on the reverse side. (Mark only one):
¨ Full Member ($75.00) ¨ Associate Member ($50.00) ¨ Consultant Affiliate ($100.00)
¨ Cooperating Affiliate ($30.00)¨ Education Affiliate ($10.00) ¨ Retired ¨ Honorary
By action of the Association’s Board of Directors, all MLGMA voting
members/full members and associate members must subscribe to the Code of Ethics
of ICMA. By completing and returning this application form, the applicant
recognizes and accepts the Board’s actions and acknowledges that he/she
subscribes to, and is bound by, the ICMA Code of Ethics.
16. Signature Date
Please return this form and mail it with your check in the proper amount made out to Michigan Local Government Management Association and mail to:
Michigan Local Government Management Association
PO Box 7409
1. Article 7, Section 1 of the Association’s Constitution and Bylaws defines eligible members. If a question of eligibility arises, an applicant’s membership fee and form will be held until the President and/or Board of Directors makes a determination as to eligibility.
2. A full membership year is from January 1 to December 31. Membership fees cannot be prorated.
3. Please inform the Association’s Executive Director of your new business address when moving from one community to another during the year so Association notices, newsletters and mailings will not be interrupted.
Membership
Categories & Dues Structure
Full Member:
Annual Dues $75.00
Associate Member: Assistants to those qualified to be “full” members.
Annual Dues $50.00
Consultant
Affiliate Member: Those members of consulting firms specializing in local government who have held “full” or “associate” membership in ICMA or in this Corporation or its predecessor. No voting privileges.
Annual Dues $100.00
Cooperating
Affiliate Member: Individuals employed by the Michigan Municipal League or a local government unit who have attained a high degree of contribution to the municipal management profession. Said members to receive initial approval by the Board of Directors with annual review thereafter. No voting privileges.
Annual Dues $30.00
Education
Affiliate Member: Faculty and students of universities and colleges located in Michigan. No voting privileges.
Annual Dues $ 10.00
Retired Member: Full and associate members who have qualified for benefits under a bonafide retirement plan and are no longer employed on a full time basis.
Annual Dues Complimentary
Honorary Member: Non-member with distinguished service to municipal management as determined by the Board of Directors. No voting privileges.
Annual Dues Complimentary