Membership Application Membership Level* Level I, Strategic Membership $150,000 Level II, Strategic Membership $100,000 Level III, Partner Membership $50,000 Level IV, Partner Membership $25,000 Level V, Support Membership $17,500 Level VI, Support Membership $10,000 Level VII, Support Membership $5,000** Level VIII, Support Membership $1,500*** Choose Firm Type* Corporate Law Department Law Firm Company 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? Yes No How 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 Attorneys Women Attorneys LGBT Attorneys Attorneys with disabilities MCCA 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.
