Join the Arkansas Professional Bail Association

Become a Member!

Membership dues are due before the first A.P.B.A. meeting. These dues entitle each company to two votes in the A.P.B.A. Please make separate checks for membreship to A.P.B.A. and for agent class fees. Checks for membership should be made out to A.P.B.A., and checks for all class fees, beginning and continuing education, should be made out to A.P.B.A. Education.

Please fill out this form and return to the A.P.B.A. office, even if your company chooses not to become a member of the association. If you hire new agents or if someone leaves your company, please notify is in writing, by fax or by mail to the P.O. Box number listed at the bottom of this form. Thank you.

PLEASE COMPLETE THIS FORM IF THERE HAVE BEEN ANY CHANGES IN YOUR COMPANY'S INFORMATION IN THE PAST YEAR.

You can print this form after you've filled it out and mail with your payment. Or, submit online and send your payment separately. Either way, this form will make it easier to join!

Please fill out the form as completely as possible. * indicates that the field is required.

*Name of company:
*Company should be listed alphabetically under:
Company code number:

*Type of company:
Sole proprietorship
Partnership
Incorporated

*Mailing address:
City:
State: Arkansas
ZIP:

Select the counties your company works in from the list below (check all that apply):

Arkansas
Ashley
Baxter
Benton
Boone
Bradley
Calhoun
Carroll
Chicot
Clark
Clay
Cleburne
Cleveland
Columbia
Conway
Craighead
Crawford
Crittenden
Cross
Dallas
Desha
Drew
Faulkner
Franklin
Fulton
Garland
Grant
Greene
Hempstead
Hot Spring
Howard
Independence
Izard
Jackson
Jefferson
Johnson
Lafayette
Lawrence
Lee
Lincoln
Little River
Logan
Lonoke
Madison
Marion
Miller
Mississippi
Monroe
Montgomery
Nevada
Newton
Ouachita
Perry
Phillips
Pike
Poinsett
Polk
Pope
Prairie
Pulaski
Randolph
Saline
Scott
Searcy
Sebastian
Sevier
Sharp
St. Francis
Stone
Union
Van Buren
Washington
White
Woodruff
Yell

*Phone:
Second phone:
Fax:

Main office address:
City:
State: Arkansas
County:
Zip:

*Designated to vote for this company:
*Second designated voter for this company:
*Proxy voters (only if owners are not present):

*Owner information. You may add up to four owners.

*Name/Title:
*Mailing address:
*City:
State: Arkansas
*County:
*Zip:

*Phone:
Second phone:
Fax:

Is owner a licensed agent? Please enter yes or no.

Name/Title:
Mailing address:
City:
State: Arkansas
County:
Zip:

Phone:
Second phone:
Fax:

Is owner a licensed agent?Please enter yes or no.

Name/Title:
Mailing address:
City:
State: Arkansas
County:
Zip:

Phone:
Second phone:
Fax:

Is owner a licensed agent?Please enter yes or no.

Name/Title:
Mailing address:
City:
State: Arkansas
County:
Zip:

Phone:
Second phone:
Fax:

Is owner a licensed agent?Please enter yes or no.

Number of agents with company currently:

Contact person:
Phone:
Mailing address (for company information):
City:
State: Arkansas
ZIP:
E-Mail:
Web Address:

Full membership gives each company two votes. If a company's designated voters are unable to attend a meeting, a proxy must be given in writing, and must be notarized, before a vote can be given by that company.

this form and mail it with your payment to Arkansas Professional Bail Association, P.O. Box 979, North Little Rock, AR 72115-0979.

Or, you can online. You will still need to mail payment to the address above. No paperwork will be processed until association has received payment.

Arkansas Professional Bail Association, #1 Sheriff's Lane, Suite C
P.O. Box 979, North Little Rock, AR 72115-0979
(501) 758-2611 - Fax (501) 758-0071
E-mail: apba@swbell.net - www.arkansasbail.com