Mid-Atlantic Regional
Gang Investigators Network
APPLICATION FOR MEMBERSHIP
2008
NAME:
LAST
FIRST
MIDDLE INITIAL
AGENCY:
TITLE/POSITION:
TYPE OF AGENCY:
AGENCY ADDRESS:
STREET
CITY:
STATE:
ZIP CODE:
AGENCY TELEPHONE:
MOBILE TELEPHONE:
PAGER:
FAX:
E-MAIL ADDRESS:
APPLICATION STATUS:
MARGIN DUES ARE
$20.00 ANNUALLY
REGULAR MEMBERSHIP
ASSOCIATE MEMBERSHIP
RETURN TO
Jeffrey T. Wennar
NEW
Assistant State’s Attorney
State’s Attorney’s Office
50 Maryland Avenue
RENEWAL
5th Floor
Rockville, MD 20850
OFFICIAL USE ONLY
DATE RECEIVED
DATE APPROVED/
DIS APPROVED