The Municipal Clerks’ Association of New Jersey

http://www.njclerks.org/cn/webforms/form.cfm?FormID=155&tpid=18590

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*Fields in Red are required.

Membership

* Fields in red are required

Membership Type:

Have you served as a MCANJ President?: Yes

Municipality:

Last Name:

First Name:

Create Password (for Website login):

Tenured:

Work Address:

City:

State:

Zip:

County:

Work Phone:

Extension:

Work Email:

Confirm Email:

Optional

Birthdate:

Home Address:

City:

State:

Zip:

Cell or Home Phone:

Home Email:

Confirm Email:

Subscribe to Email Lists:

Quill Newsletter by email.

Quill Newsletter by regular mail.

Receive information about job postings.

Payer Information

Billing Name:

Address:

Address 2:

City:

State:

ZIP Code:

Daytime Phone:

Payer E-mail Address:

Payment Information

Payment Amount: $ Enter amount.

Payment Method:

Credit Card:

Convenience Fee:

Credit Card Number:

Sec. Code:

What is the Security Code?.

What is this and why do I have to do it?
Due to the amount of credit card fraud over the internet, banks will soon REQUIRE this information to process credit card orders online - you can expect to see it used everywhere in the very near future. Your benefit is that it prevents any fraudulent charges using your credit card, i.e. no one can pick up an old receipt of yours and use that info to fraudulently use your credit card. Thanks for your cooperation.

American Express
4 digits on front of card

Visa and Mastercard
last 3 digits on back of card

Note: The digits are printed on your card, rather then stamped in the plastic like the digits in your credit card number.

Exp. (Month/Year):

(2 digits, Range: 24-34)

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