OUTLOOK

ILLINOIS PROBATION AND COURT SERVICES ASSOCIATION2013 MEMBERSHIP FORM(January 1st - December 31st)Members are the backbone of this Association and your interest in becoming a member is appreciated. IPCSA has an activemembership of approximately 700 members and is considered one of the largest state probation associations in the U.S.(Completing all of the requested information will ensure that you receive all future mailings to the correct address.) First Time Member $25.00 Membership Renewal $50.00 Student Membership—$25.00Name:______________________________________________Position/Title:_____________________________County and Department Name:__________________________________________________Circuit_____________Mailing Address: ____________________________________________________________________________________________________________________________________________________________Daytime Phone #: () ___________________________ E-mail Address:__________________________________Home Address: __________________________________________________________________________________________________________OPTIONALMEMBERSHIP FEE PAID FOR BY: Department Applicant Have been an IPCSA Member since:__________MY JOB FUNCTION FALLS IN THE FOLLOWING GENERAL CATEGORIES: Adult Probation Pretrial Services Juvenile Probation Juvenile Detention __________________(Other)MY POSITION FALLS IN THE FOLLOWING CATEGORY: Director Chief Managing Officer Supervisor Line Officer AA/Office Manager Support StaffI AM INTERESTED IN LEARNING MORE ABOUT THE FOLLOWING COMMITTEE(S):Awards CommitteePretrial Committee Nomination/Election CommitteeDay/Evening Report Center Committee Program CommitteeDetention Committee Resource CommitteeDomestic/Family Violence Committee Sex Offender CommitteeGender Responsive Committee Substance Abuse CommitteeLegislative Committee (CMO approval required) Technology CommitteeMembership Committee Victim Services CommitteePlease send this application with your membership dues, made payable to IPCSA, to the following address:IPCSAPO Box 474Effingham, IL 62401Questions? Email ipcsa@live.comThis form is also available on our website: www.ipcsa.orgJoinIPCSA