Connecticut Renewal Form for Justices of the Peace Association

jpUS Connecticut
Renewal/Change Form

Justices of the Peace of the U.S.

Attention, Current Members of jpUS.org from Connecticut

If you are currently a member of the Justice of the Peace Association and renew before your JP Association term expires, please use this form to renew.

(If you are a NEW member, please use the New Member form to register.)

Required fields are in *red and marked with an asterisk.

Changes.
You may use this form to add additional towns to your listing.
If you are a current member changing information on your listing, enter 0 in Total Amount and Submit Form.

A. Contact Information
*Your Name
Address (if changed):		Check here if you do not want your street address to be listed
Town or City:		Connecticut
Zip:	(99999-9999)
Email (for your listing):
Home Phone (if changed):	(999-999-9999)
Business Phone (if changed):	(999-999-9999)
The URL of your own web site

B. More About You

Religion:

Other :

Ethnicity:

Other :

Political Party:

Other :

Foreign Languages spoken:

French

Spanish

Hebrew

Italian

German

Russian

Polish

Other foreign languages spoken

Will you perform Marriages?

Anything you want to say about yourself? (e.g., services, background - 25- word maximum)

If you're making a change, please tell us what has changed (if it's not self-evident).

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 the State in which I am empowered, 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.

C. Rates for On Time Renewals

1 Year $50
Remainder of Full Term - 3 years $135
No charge - change only

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

	No. of additional pages
Membership Term	1-5 additional towns	6-10 additional towns	11 -15 additional towns	16 or more additional towns
1 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 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 per year). That includes your town too.

* Total amount (please add C and D): $
(Enter zero if Change only).

Will you pay by credit card (fast and secure) or mail a check?

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