Michigan Sheriff''s Mounted Association
County Applying for Membership *

Sheriff

Name *

Prefix
First
Last
Suffix
Address *

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Phone Number *

###		-
###		-
####
Fax Number

###		-
###		-
####
Email

Under Sheriff

Name *

Prefix
First
Last
Suffix
Phone Number *

###		-
###		-
####
Email

Liaison Officer

Name *

Prefix
First
Last
Suffix
Phone Number

###		-
###		-
####
Email

Mounted United
1st Officer

Name & Rank *
Address *

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Phone Number *

###		-
###		-
####
Email *

2nd Officer

Name & Rank *
Address *

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Phone Number

###		-
###		-
####
Email

County Representative

Represents your county at MSMA meetings.
Name & Rank
Address

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Phone Number

###		-
###		-
####
Email

Correspondence

To whom all correspondence is sent *
 Sheriff 
 Under Sheriff 
 Liaison Officer 
 1st Officer 
 2nd Officer 
 County Representive 
 Other 
Other
Name & Rank
Address

Street Address

Address Line 2

City
State / Province / Region

Postal / Zip Code
Country
Email

Number of Members

Dues are $50 + $1 per regular member & Active Life Members// Dues are due before the March .
Number of Regular Members
Active Life Members
Non Active Life Members

Questions
Email
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