Annual Membership Application

Name:_________________________________________ Rank/Title:_______________

Agency/Company:________________________________________________________

Mailing Address:_________________________________________________________

City:__________________________________State:_______           Zip Code:_________

Phone: (___)__________  Fax: (___)__________

E-mail: _________________________________________________________________

Your Agency/Company has implemented:

·         Crime Free Multi-Housing

·         Crime Free Hotel/Motel

·         Crime Free Mobile Housing

·         Crime Free Mini-Storage

·         Other ________________

Are you interested and able to serve on a committee?        Yes  No

Are you interested and able to serve as a board member?  Yes  No

Dues are $25.00 per year for Law Enforcement and Associate members OR $75.00 per year for agencies/companies (provides for four memberships)

Make check or money orders to:  Mid-America Crime Free, INC

Mail to: (or deliver to any current board member)

Mid-America Crime Free, INC           

Bob Wise, Executive Director MACF

P.O. Box 480187

Kansas City, MO 64148-0187

Office use only:

Membership Accepted:  Yes  No (reason_________________________________________________)

Renewal or New? _________

Dues paid for: (year) ______