Membership Form
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Membership Application Established 1973
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Annual Fee: $50.00
C/o Kevin Kuroda
NLSSA Treasurer
House Sergeant at Arms
State Capitol, Room 017
Honolulu, HI 96813
(808) 586-6500 FAX (808) 586-6501
kuroda@capitol.hawaii.gov
MEMBERSHIP CATEGORIES (Please select one):
____ACTIVE MEMBER Individuals renewing their NLSSA membership and who serve state legislatures as sergeant-at-arms, law enforcement officers, and others in an administrative, service or security related capacity that are not otherwise eligible to join other staff sections of the National Conference of State Legislatures.
____NEW MEMBER Individuals seeking membership for the first time in NLSSA, and who serve state legislatures as sergeant-at-arms, law enforcement officers, and others in an administrative, service or security related capacity who are not otherwise eligible to join other staff sections of the National Conference of State Legislatures.
____ACTIVE ASSOCIATE MEMBER Individuals wishing to renew their NLSSA membership as an Associate Member and who have a peripheral interest in, and who will be of benefit to the association. Associate Members shall enjoy all privileges of the association except voting privileges.
____NEW ASSOCIATE MEMBER Individuals seeking membership for the first time in NLSSA and who have a peripheral interest in the organization and who will be of benefit to the association. Associate Members shall enjoy all privileges of the association except voting privileges.
____ADVISORY MEMBER Individuals serving as elected State Legislators wishing to seek membership in NLSSA. Advisory Members serve on the NLSSA Legislative Advisory Committee and will have a vote on the executive board.
Please enclose a black & white photo of yourself if you wish to change your photo in the roster.
Last Name_________________________________________ First Name________________________________________ Initial_____________________________
Title______________________________________________ Organization_________________________________________________________________________
Full Address____________________________________________________________________________________________________________________
Business Phone (_____) ___________________________________ FAX (_____) _________________________________________
E-Mail: _________________________________________________ Home Phone: _______________________________________________________________
Name of Spouse (If Applicable):____________________________________________
Areas of Expertise (i.e. CPR certified, office administration, chamber security, capitol security, page programs, facility management, capitol tours, historic preservation, nurse, EMT, threat assessment, conflict resolution, etc.) ___________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
If you work in security, are you a commissioned peace officer? ______________
Education (college, high school, special training):
_________________________________________________________________________________________________________________________________________
Professional - Business & Career (positions you have held, professional associations) :
_________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
Community (community activities & organizations) :
_________________________________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________
Awards & Honors (please list any significant awards received and date):
_________________________________________________________________________________________________________________________________________
Military Service:____________________________________________________________________________________________________________________________
Please make checks payable to NLSSA and remit payment to:
KevinKuroda
NLSSATreasurer
HawaiiLegislature
State Capitol, Room 017
Honolulu, HI96813
NOTE:
Postmark deadlines for remittance are July 1 and September 1.
Dues received and postmarked on, or before, July 1 will entitle eligible members to be nominated or to seek election to a national or regional office at the NLSSA Annual Training Conference business meeting, pursuant to Article VI, Section 4 (c) of the bylaws of the Association.
Dues received and postmarked on, or before, September 1 will entitle eligible members to vote at the NLSSA Annual Training Conference business meeting, pursuant to Article VI, Section 4 (a) of the bylaws of the Association.
For more information about NLSSA, write or call:
Morgan Cullen, NCSL Liaison to NLSSA
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