Connecticut Justices of the Peace Membership Form

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jpUS CT New Member Registration

Justices of the Peace of the U.S.

This form is for Connecticut Justices of the Peace who are not yet members of jpUS.

If you are a CURRENT member of jpUS, please use the Renewal form to register.

Note: Required fields are preceded with *.

A. Contact Information
*First Name		M.I.
*Last Name:
*Address:		Check here if you do not want your street address to be listed
*Town or City:		CT
County
*Zip:	(99999-9999)
*Email:
Home Phone:	(999-999-9999)
Business Phone:	(999-999-9999)
Cell Phone:	(999-999-9999)
The URL of your own web site
Social networking link (facebook, linkedin, etc.

B. More About You (optional)

Religion:

Other :

Ethnicity:

Other :

Political Party:

Other :

Foreign Languages spoken:

French

Spanish

Hebrew

Italian

German

Russian

Polish

Other foreign languages spoken

I do do not perform marriages.

Anything else you want to say about yourself? e.g., services, background, anything special that you offer that might be important to potential clients. (25- word maximum)

Members of jpUS must agree to abide by the following Code of Ethics:

As a member of the Justice of the Peace Association of the U.S. (jpUS.org), having accepted the responsibility of the office of Justice of the Peace, in order to faithfully discharge my duties with both competence and integrity, I resolve that I will adhere to the following standards of conduct:

To execute the statutes of Connecticut, as promised when I took the oath of office
To perform all tasks and responsibilities to the best of my ability
To complete and submit all documentation accurately, on time and to the proper authorities
To be honest with my clients and to act in their best interests
To charge a fee for my services that reflects my expertise, effort, time and involvement in the preparation and performance of my duties and that is in compliance with state statute, if applicable
To always act in a manner that reflects favorably on myself, my office, and the Justice of the Peace Association.

* As a member of jpUS, I agree that I will always abide by this Code of Ethics. Yes

C. *Select membership term (current year or full term)

Fee for CURRENT YEAR depends on the month you join.
Please click circle FOLLOWING month.

Jan-$60 Feb-$55 March-$50 April-$45 May-$40 June-$35
July-$30 Aug-$25 Sept-$20 Oct-$15 Nov and Dec -$65 (includes all of the next year)

Fee for FULL TERM (now through Jan 7, 2013) depends on the month you join. Please click circle FOLLOWING month.

Dec '09 or Jan '10 - $170    Feb-$165    Mar-$160    April- $155    May-$150
   June-$145     July-$140     Aug-$135     Sept-$130   Oct-$125
                Nov-$120 Dec-$115

Your primary listing will appear in the directory of the town or city where you were appointed.

D. Other Options

Option D1
You may choose to be listed on additional pages in Connecticut. All listings must be for the same membership term.

Pricing for listings in Additional Towns
If it's after January, please ask for lower rates.

	No. of additional pages
Membership Term	1-5 additional towns	6-10 additional towns	11 -15 additional towns	16 or more additional towns
Full Year	$35 per town	$30 per town	$25 per town	$20 per town
Remainder of Full Term (3 yrs)	$90 per town	$80 per town	$70 per town	$55 per town

In addition to your town of appointment, how many additional pages do you wish to be listed in?

Please type additional towns or cities in the next box.

D1 Cost for Additional Towns.
(Multiply Number of additional pages by Price for your Membership Term) $

Option D2

You may choose to be listed on every page of a Connecticut County:

Pricing for Countywide Listings

County
No. Towns

Select
(add to basic membership)

Full Year Remaining Full Term
(3 years)

Fairfield 23 $425 $1200

Hartford 29 $550 $1500

Litchfield 26 $495 $1240

Middlesex 15 $300 $845

New Haven 27 $510 $1380

New London 21 $390 $1100

Tolland 13 $260 $725

Windham 15 $300 $845

Option D3
You may choose to be listed in all 169 towns in the state. Price for one year is $2850(which is less than $17 per town). That includes your town too.

E. Total amount (please add C and D): $
Please select a method of payment: credit card check

If paying by check, please pay to the order of jpUS and mail to
jpUS, 8 Webb Road, Westport CT 06880. Thank you.