AJA Membership Application/Renewal Payments

* Fields marked with an asterisk are required.

First Name*

Last Name*

Title*

Name of Court

Referred by

Address *

City *

State *

Zip Code *

Country*

Work Telephone*

Fax

Email *

*Annual Dues:

$175.00 Active
$65.00 Retired
$400.00 for three years of membership
Free Year - Newly elected/appointed (within the last twelve months)
Free Year - Gift Membership (must provide "Referred By" name in the first section above)

TOTAL DUE: $0

* Payment Information:

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