Full Legal Name(Required) First Last Nickname Contact Telephone(Required)Email Address(Required) Mailing Address(Required) Street Address City State / Province / Region ZIP / Postal Code Untitled County(Required)SelectAlamedaAlpineAmadorButteCalaverasColusaContra CostaDel NorteEl DoradoFresnoGlennHumboldtImperialInyoKernKingsLakeLassenLos AngelesMaderaMarinMariposaMendocinoMercedModocMonoMontereyNapaNevadaOrangePlacerPlumasRiversideSacramentoSan BenitoSan BernardinoSan DiegoSan FranciscoSan JoaquinSan Luis ObispoSan MateoSanta BarbaraSanta ClaraSanta CruzShastaSierraSiskiyouSolanoSonomaStanislausSutterTehamaTrinityTulareTuolumneVenturaYoloYubaLatest fiscal years served on grand jury (Enter years below like 2023/24)(Required)
