Conference of California Bar Associations

CCBA Certification of Membership Form

On behalf of:
Enter name of Bar Association
I certify the following:
MEMBERS
The number of members of said Association in good standing who are members (whether active or inactive) of the State Bar and whose principal offices are inside the county served by the Association:

The number of members of said Association in good standing who are members (whether active or inactive) of the State Bar and whose principal offices are outside the county served by the Association:

The number of members of the Association who are Judges of Courts or Record or are not members of the State Bar:

Total membership:
TYPE OF ORGANIZATION
This is a statewide organization:
This is a multi-county organization:
I hereby further certify that this Association has complied with all provisions of Article VII of the Rules of the Conference of California Bar Associations.
INFORMATION ABOUT PERSON COMPLETING THIS FORM
Full Name:
Telephone Number: 000-000-0000
Email Address:
OTHER REQUIRED INFORMATION
Full Name of Association's current CCBA Delegation Chair
Email address of Association's current CCBA Delegation Chair
If your association assigns a staff member to the delegation, please provide the following information:
Full Name
Email Address
Telephone Number 000-000-0000
Association's permanent contact information:
Name
Email Address
Telephone Number 000-000-0000
Please include all CCBA notices to:
Chair:
Permanent Contact:
Staff Contact: