Membership Application Membership Level*Level I, Strategic Membership $150,000Level II, Strategic Membership $100,000Level III, Partner Membership $50,000Level IV, Partner Membership $25,000Level V, Support Membership $17,500Level VI, Support Membership $10,000Level VII, Support Membership $5,000**Level VIII, Support Membership $1,500***Choose Firm Type*Corporate Law DepartmentLaw FirmCompany InfoCompany Name*Industry*General Counsel Name*General Counsel Complete Title*General Counsel Email* General Counsel Phone*General Counsel Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code MCCA Membership Point of Contact (POC)Membership POC Name*Membership POC Title*Email* Phone*Mailing Address* Same as GC Mailing Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Firm InfoFirm Name*Managing Partner Name*Email* Phone*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Diversity Chair InformationDiversity Chair/Director/Manager Name*Diversity Chair/Director/Manager Complete Title*Diversity Chair/Director/Manager Email* Diversity Chair/Director/Manager Phone*Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code MCCA Membership Point of Contact (POC)MCCA Membership Point of Contact (POC) Name(If different from Diversity Chair/Director/Manager)MCCA Membership Point of Contact (POC) Title(If different from Diversity Chair/Director/Manager)PhoneEmail Mailing Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you a Minority/Women owned law firm?YesNoHow many full-time attorneys are employed in your legal department or law firm?*How did you hear about MCCA?*Why do you want to join MCCA?*Law Firm Demographics (include all U.S. offices only)Enter Number of AttorneysMinority AttorneysWomen AttorneysLGBT AttorneysAttorneys with disabilitiesMCCA is exempt under Section 501(c)(3) of the Internal Revenue Code. Tax ID #13-3920905** Reserved only for law firms with less than 100 full-time attorneys and less than 10 full-time attorneys for corporate legal departments.*** Reserved only for small law firms, which is defined as having less than 10 full time lawyers in the firm and less than 3 in corporate law department.CommentsThis field is for validation purposes and should be left unchanged.
