MEMBERSHIP APPLICATION

mcca MEMBERSHIP Application

"*" indicates required fields

Membership Level*

Level I, Strategic Membership $150,000

Level II, Strategic Membership $100,000

Level III, Partner Membership $50,000

Level IV, Partner Membership $25,000

Level V, Support Membership $17,500

Level VI, Support Membership $10,000

Level VII, Support Membership $5,000**

Level VIII, Support Membership $1,500***

Choose Organization Type*

Corporate Law Department

Law Firm

DEI Committee Chair Information

Diversity Chair/Director/Manager Name*

Diversity Chair/Director/Manager Title*

Diversity Chair/Director/Manager Email*

Diversity Chair/Director/Manager Phone*

Diversity Chair/Director/Manager Mailing Address

Same as Main Office/HQ Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Hidden

Does your legal department currently have a Chief Diversity Officer/Director/Manager? If yes, please provide information on the Chief Diversity Officer/Director/Manager below.*

Yes

Chief Diversity Officer/Director/Manager Information

Chief Diversity Officer/Director/Manager Name*

Chief Diversity Officer/Director/Manager Title*

Chief Diversity Officer/Director/Manager Email*

Chief Diversity Officer/Director/Manager Phone*

Chief Diversity Officer/Director/Manager Mailing Address

Same as Main Office/HQ Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

General Counsel Information

General Counsel Name*

General Counsel Official Title*

General Counsel Email*

General Counsel Phone*

General Counsel Mailing Address

Same as Main Office/HQ Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Executive Assistant Name

Executive Assistant Email

Executive Assistant Phone

Law Firm Information

Law Firm Name*

Main Office/Headquarters Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have any offices located in the following regions?

Does your law firm currently have a DEI (Diversity, Equity & Inclusion) committee or equivalent? If yes, please provide information on the DEI Committee Chair below.*

Yes

DEI Committee Chair Information

Diversity Chair/Director/Manager Name*

Diversity Chair/Director/Manager Title*

Diversity Chair/Director/Manager Email*

Diversity Chair/Director/Manager Phone*

Diversity Chair/Director/Manager Mailing Address

Same as Main Office/HQ Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Hidden

Does your law firm currently have a Chief Diversity Officer/Director/Manager? If yes, please provide information on the Chief Diversity Officer/Director/Manager below.*

Yes

Chief Diversity Officer/Director/Manager Information

Chief Diversity Officer/Director/Manager Name*

Chief Diversity Officer/Director/Manager Title*

Chief Diversity Officer/Director/Manager Email*

Chief Diversity Officer/Director/Manager Phone*

Chief Diversity Officer/Director/Manager Mailing Address

Same as Main Office/HQ Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Managing Partner Information

Managing Partner Name*

Managing Partner Official Title*

Managing Partner Email*

Managing Partner Phone*

Managing Partner Mailing Address

Same as Main Office/HQ Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Executive Assistant Name

Executive Assistant Email

Executive Assistant Phone

MCCA Membership Point of Contact (POC)

MCCA Membership POC Name

(If different from Diversity Chair/Director/Manager)

MCCA Membership POC Title

(If different from Diversity Chair/Director/Manager)

MCCA Membership POC Phone

(If different from Diversity Chair/Director/Manager)

MCCA Membership POC Email

(If different from Diversity Chair/Director/Manager)

MCCA Membership POC Mailing Address

Same as Main Office/HQ Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Hidden

Are you a Minority/Women owned law firm?

Yes

Demographics (Include All U.S. Offices Only)

If there are no attorneys in the fields below, please type "0". If this data is not collected, please type N/A.

Total Number of Full-Time Attorneys (U.S. only)*

Underrepresented Racial/ Ethnic Attorneys*

Women Attorneys*

LGBTQ+ Attorneys*

Attorneys with Disabilities*

Military Veterans Attorneys*

Demographics (Include All U.S. Offices Only)

If there are no attorneys in the fields below, please type "0". If this data is not collected, please type N/A.

Total Number of Full-Time Attorneys (U.S. only)*

Underrepresented Racial/ Ethnic Attorneys*

Women Attorneys*

LGBTQ+ Attorneys*

Attorneys with Disabilities*

Military Veterans Attorneys*

Additional Questions

How did you hear about MCCA?*

Why do you want to join MCCA?*

Please share your organization’s DEI Mission Statement (if available):

MCCA is exempt under Section 501(c)(3) of the Internal Revenue Code. Tax ID #13-3920905

** Reserved only for law firms with less than 100 full-time attorneys or corporate legal departments with less than 10 full-time attorneys.

*** Reserved only for law firms with less than 10 full time attorneys or corporate legal departments with less than 3 full time attorneys."

This field is for validation purposes and should be left unchanged.

MEMBERSHIP APPLICATION

mcca MEMBERSHIP Application

Company Information

DEI Committee Chair Information

Chief Diversity Officer/Director/Manager Information

General Counsel Information

Law Firm Information

DEI Committee Chair Information

Chief Diversity Officer/Director/Manager Information

Managing Partner Information

MCCA Membership Point of Contact (POC)

Demographics (Include All U.S. Offices Only)

Demographics (Include All U.S. Offices Only)

Additional Questions

STRATEGIC MEMBERS 2023

STRATEGIC MEMBERS 2023

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