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MID-MICHIGAN CODE OFFICIALS ASSOCIATION MMCOA 2016 MEMBERSHIP APPLICATION MEMBER INFORMATION MEMBER NAME PRINT MUNICIPALITY / COMPANY MAILING ADDRESS CITY STATE PHONE INCLUDE AREA CODE PA 54 REGISTRATION NUMBER RESIDENTIAL BUILDER LICENSE NUMBER IF APPLICABLE YES NO ICC MEMBER BUILDING OFFICIAL ELECTRICAL INSPECTOR ZIP CODE IF YES ICC BUILDING INSPECTOR MECHANICAL INSPECTOR PLAN REVIEWER PLUMBING INSPECTOR MEMBERSHIP OPTIONS REGULAR MEMBER ASSOCIATE MEMBER HONORARY MEMBER 60 ANNUALLY Members who currently have a valid Act 54 registration and are actively enforcing the code. PAYMENT Membership dues can be made by cash or check. Cash payment will only be accepted in person at any class. Not by mail Application and membership payment is due by March 31 2016. In order to attend class member dues will need to be paid in full* Checks accepted in person at any class or by mail* Payments and application will both need to be submitted together. MAIL CHECKS TO th Members attending the March 10 class will need to provide application with dues at that time. East Lansing Post Office 1140 Abbot Road PO Box 4974 East Lansing MI 48826 CHECKS PAYABLE TO Mid-Michigan Code Officials Association SIGNATURE SIGN HERE DATE X The above information is accurate to the best of my knowledge. CONTACT INFORMATION OFFICE USE ONLY Glen Dempsey Building Code Administrator City of East Lansing Building Department Date Received Phone 517 319-6878 Payment Method E-mail gdempse cityofeastlansing*com Cash Check. PAYMENT Membership dues can be made by cash or check. Cash payment will only be accepted in person at any class. Not by mail Application and membership payment is due by March 31 2016. In order to attend class member dues will need to be paid in full* Checks accepted in person at any class or by mail* Payments and application will both need to be submitted together. Not by mail Application and membership payment is due by March 31 2016. In order to attend class member dues will need to be paid in full* Checks accepted in person at any class or by mail* Payments and application will both need to be submitted together. MAIL CHECKS TO th Members attending the March 10 class will need to provide application with dues at that time. MAIL CHECKS TO th Members attending the March 10 class will need to provide application with dues at that time. East Lansing Post Office 1140 Abbot Road PO Box 4974 East Lansing MI 48826 CHECKS PAYABLE TO Mid-Michigan Code Officials Association SIGNATURE SIGN HERE DATE X The above information is accurate to the best of my knowledge. East Lansing Post Office 1140 Abbot Road PO Box 4974 East Lansing MI 48826 CHECKS PAYABLE TO Mid-Michigan Code Officials Association SIGNATURE SIGN HERE DATE X The above information is accurate to the best of my knowledge. CONTACT INFORMATION OFFICE USE ONLY Glen Dempsey Building Code Administrator City of East Lansing Building Department Date Received Phone 517 319-6878 Payment Method E-mail gdempse cityofeastlansing*com Cash Check.

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