Full Legal Name

Address

Address

Apartment Number

City

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Main Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Washington D.C.      Zip Code

Home Phone    Work Phone

Fax    Cell Phone     Pager

E-Mail Address

Web Page Address

Type 1 Type 2 Type 3 Type of Constable Commission currently held (mail copy of card)

Regular Probationary Associate Type of Membership for which you are applying

Regular - Already a constable
Probationary - Soon to be a constable
Associate - Full time law enforcement officer

  AD Number

Registered Voter

County where registered to vote

Mail dues to:   S.C. State Constables Alliance
                          P.O. Box 1745
                          Myrtle Beach, SC  29578-1745

$40.00 per year 

Check Number        Amount

Date Mailed

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