Mid-Atlantic Cold Case Homicide Investigators Association

Name:  ___________________________________________________________________

Title:  ___________________________________________________________________
[  ] Active  [  ] Retired

Organization: ________________________________________________________

Important: Check which address you wish mail to be sent but please include info on both.

[  ]  Business Street Address:  _________________________________________________

City:  ___________________ State:  ____ Zip: _________

Business Phone:  ____________________________________________________________

Business E-mail:  ____________________________________________________________

[  ]  Home Street Address:  ___________________________________________________

City:  ________________________________ State:  ___ Zip:________

Home Phone:  _______________________________________________________________

Home E-mail:  _______________________________________________________________

Length of time in law enforcement: ____________________________________________

Mail your completed application form and check (made payable to MACCHIA) to:

P.O. Box 611
Annapolis, MD. 21404
Annual Dues:  (Indicate One)
_______________    $25.00    Active Membership
_______________    $25.00    Associate Member