You will need the following information in order to complete the application:
Copiah County, MS Forrest County, MS Hancock County, MS Harrison County, MS Hinds County, MS Holmes County, MS Jackson County, MS Jefferson Parish, LA Lincoln County, MS Madison County, MS Mobile County, AL Orleans Parish, LA Pearl River County, MS Plaquemines Parish, LA Rankin County, MS Simpson County, MS St Bernard Parish, LA St Charles Parish, LA St James Parish, LA St John Parish, LA St Tammany Parish, LA Warren County, MS Yazoo County, MS
I am an immediate family member I live in the same household as family member Spouse Parent Grandparent Sibling Child Grandchild Significant Other
Active Duty Civilian Personnel Military Reserve Retired Military
American Cancer Society Cancer Action Network, Inc-Residents of Alabama, Louisiana and Mississippi only. Combat Wounded Veterans of South MS (in branch or existing members only)
A. Garner Russell AAA Conditioned Air ABC Child Development Center Academy Sports and Outdoors Academy Sports and Outdoors in Hattiesburg Advanced Collision Service Advanced Collision located in Hattiesburg Advanced Marine Incorporated AGJ Systems & Networks Alexander & Shelton Agency, LLC Alion All Signs Allen & Smith Insurance Agency American Cancer Society Action Network, Inc.-Residents of Alabama, Louisiana and Mississippi only. American Heart Association Gulf Coast who work or paid from Gulfport, MS American Identity American Legion Post 77 American Medical Response Anderson Design Center employees who work in or are paid or supervised from Hattisburg, MS Animal General Hospital Animal Hospital of Orange Grove Animal Medical Center- Employees of Animal Medical Center who work in or are supervised from Hattiesburg,MS Anytime Fitness/Wiggins Apple Construction Astro Ford AT&T Call Center AT&T/Edgewater AT&T/Gautier AT&T/Gulfport At&T/Ocean Springs AT&T/Orange Grove AT&T/Pascagoula Azalea Gardens Nursing Center B1 Nursing - Employees of B1 Nursing who work in , or are paid or supervised from Pearl, Mississippi B & D Enterprize Construction LLP B & J Leasing Inc. d/b/a Burnham Auto Sales BackFlow Specialist, LLC Back Porch Realty Baldwin Pole Mississippi, LLC Bankston's Paint Bay Motor Winding, Inc. Bay Waveland School District Bayside Chrysler Plymouth Dodge BE&K Construction Co., Port Bienville Beau Rivage Resorts, Inc. Bell Avon Bernadette Levens Tolson, CPA Bienville Medical Clinic Bienville Orthopedic Specialists Big Level Trucking - Employees who work in, or are paid or supervised from Wiggins, MS Biloxi Housing Authority Biloxi Internal Medicine, P.A. Biloxi/Ocean Springs Board of Realtors Bleil & Wakham, P.A. Blossman Propane Gas Appliance and Services Employees Blue Bell Creameries, L.P. Bob Dean Allstate Insurance Boomtown Casino Boyington Health Care Facility BP-Amoco Pascagoula Gas Processing Plant Bradford-O'Keefe Funeral Home, Inc. Brass Hanger Cleaners Brewer Optical & Eyecare Clinic Brian Harris Autoplex Brinks Browning Ferris Industries, Inc. (BFI) Bryan Blakeney, DMD Bryan, Nelson, Schroeder, Castigliola & Banahan Bullard Homes Bullock Investigation Security Bundle of Love Day Care Bureau of Alcohol, Tobacco & Firearms Butch Oustalet Ford & Lincoln Mercury Butterfield Investment Company C & C Office Supply, Inc. C & M Enterprises d/b/a Spherion Staffing-South MS C&C Mini Storage Cable One CableMan, Inc. Calgon Carbon Corporation, Pearl River Plant Camellia Gardens Retirement Community Camellia Healthcare Campground Baptist Church Canton Municipal Utilites employees who work in or are paid or supervised from Canton, MS CARES Center Inc. Carpenters Pole and Piling Company Carl Nulta Insurance Cedar Lake Christian Academy & Assembly Cedar Lake Surgery Center Central Steel Magnolias Susan G. Komen For the Cure employees and Board of Directors CFW, JR LLC (dba Kidz Klub House and Charlottes Web School) Employees who work in, or are paid or supervised from Slidell, LA. � Central Vending Company, Inc. Champion Chrys., Plym., Dodge, Pontiac, Buick, GMC Chandeleur Outfitters Charles Lowe Insurance Agency Charles Perniciaro Auto Repair Charlie Henderson Ford Charter West Mortgage LLC ChillCo Comprehensive Cooling Solutions Chinese Express Restaurant Christ Episcopal Church in Slidell, LA Christian Collegiate Academy Church of Christ City of Brandon employees who work in, or are paid or supervised from Brandon, MS City of Bay St. Louis City of Byram, MS City of Covington, LA employees City of D'Iberville City of Flowood, MS City of Gautier City of Gulfport City of Long Beach City of Mandeville City of Ocean Springs City of Pass Christian City of Richland City of Ridgeland - Employees of City of Ridgeland who work in Ridgeland, MS City of Slidell City of Waveland Coast Cardiology Coast Transit Authority Coastal Chronic Pain Services, PLLC Coastal Dust Control Coastal Paper Company Coca-Cola Bottling Company, United of Ocean Springs employees who work in or are paid or supervised from Vancleave, MS Coldwell Banker / Alfonso Realty Communication Workers of America, Local 3519 (CWA) Compton Engineering P.A./Biloxi Compton Engineering P.A./Pascagoula Compton Engineering, P.A./Bay St. Louis Compton's Appliance, Inc. Continental Aluminum Conway's Family Pub employees who work in, or are paid or supervised for Hattiesburg, MS Corporate Management Inc. Cotton Blues employees who work in are paid or supervised from Hattiesburg, MS Crossway Group LLC Cross Gates Family Fitness Crown Dodge Chrysler Jeep Eagle, Inc. Cuevas Gas Company Cuevas Machine Company D and R Industrial Services LLC Dallas Flint Consulting Danny Miller Plumbing, Inc. Dauro's Auto Repair David Poulos Tire & Auto David W. Tuminello, DDS Dawn Busters Kiwanis Club - Employees and Voting members of Dawn Busters Kiwanis Club in Metairie, LA who qualify for membership in accordance with its charter and bylaws in effect on 05/01/2017. Delta Title and Escrow Company Desoto Treated Materials Inc., Desporte's Biloxi Paper Co. & Office Supplies Diamondhead Fire Protection District of Hancock Co Diaz Insurance Services Dickinson, Ros, Wooten & Samson Attorneys Digestive Health Center Digital Engineering & Imaging Inc. Dogwood Hills Golf Club Domino's Pizza Donald L Kannady Colonial Life/Wiggins Dr. Glenn Cook Dr. Jules Eustice Dr. Marvin P. Liberto Driftwood Landscape DSC Dredge LLC employees who work in, or are paid or supervised from Poplarville, MS E.I. DuPont de Nemours & Company E.J. Dennis and Associates Earth Walk Shoes - Employees of Earth Walk Shoes who work in Flowood, MS. Edgewater Cleaners Edgewater Mall Edward Wheeler, D.D.S. El Saltillo Elise Epperson and Associates, Attorney at Law Ellen C. Bonner & associates Attorneys at Law ELM Construction Employees and Staff of the Southern Mississippi Alumni Association Employee Benefits Specialists Employees of the Gulf Coast Junior College District who work in Stone, Harrison, Jackson and George Counties Employees of Ross F.Lagarde- A Professional Law Corporation who work in, or are paid or supervised from Slidell,LA Employees of Dunn Paper who work in, or are paid, or supervised from Wiggins, MS. Employees of Legacy Buick GMC who work in, or are paid or supervised from Slidell, LA. Employees of Mississippi Department of Human Services who work in, or are paid or supervised from Jackson, MS. Employees of Mississippi Department of Public Safety who work in, or are paid or supervised from Jackson MS. Employees of Northshore Humane Society who work in, or are paid, or supervised from Covington, LA. Employees of Ocean Marine Group who work in, or are paid or supervised from Daphne, AL Employees of Ocean Marine Group who work in, or are paid or supervised from Ocean Springs, MS Employees of Total Health Urgent Care who work in, or are paid or supervised from Covington, LA. Environmental Management Services Eye Associates of the South East St. Tammany Chamber of Commerce Employees and members Estabrook Motor Company, Inc. Family Frozen Foods Fassbender Insurance Employees who work in, or are paid or supervised from Slidell, LA. � Fastenal Industrial & Construction Supplies Federal Aviation Administration (FAA) Federal Bureau of Investigation/Gulfport Federal Bureau of Investigation/Pascagoula Federal Highway Administration Ferson Technology First American Plastics Molding Enterprise First Baptist Church Flower Patch Florist Gourmet Gift & Bakery Flying J Travel Plaza and Cookery Restaurant Frank P. Corso Fred Walker Insurance Gaddy Eye Clinic Garden Park Medical Center GE Plastics Geiger Heating & Air Gold Coast Service Master Goulet Chiropractic Clinic Grace Baptist Academy Grace Church Gulf Coast Grand Casino Biloxi Guild & Hardy Architects Gulf Coast Association of Realtors, Inc. Gulf Coast Business Services Corporation Gulf Coast Children's Clinic Gulf Coast Eye Center Gulf Coast Oral & Facial Surgery Gulf Coast Physical Medicine Gulf Coast PreStress Gulf Coast Produce Gulf Coast Psychotherapy Gulf Coast Surgery Center Gulf Concrete Gulf Islands National Seashore Gulf National Companies Gulf Office Systems Gulf Office Systems Gulf Publishing Company Gulf South Surgery Center Gulf States Marine Fisheries Commission Gulfport Anesthesia Gulfport OBGYN H. Walker LLC ( dba Honeycomb School and Child Development Center) Employees who work in, or are paid or supervised from Slidell, LA. Hal Schrock, D.D.S. Half Shell Oyster House, Hattiesburg Hampton Inn who works in or are paid or supervised from Slidell, LA Hancock County School District Hancock County, Employees of Hancock County Disabled American Veterans Association # 50 Hancock Medical Center Handsboro Animal Hospital Hard Rock Casino Harrison County AFT Harrison County, Employees of Hartson-Kennedy Cabinet Top Co, Inc. Hattiesburg Area Association of Realtors Health First Chiropractic Center HeartSouth,PLLC,Hattiesburg, MS Heidelberg Enterprises d/b/a Qucik Check Services Heidelberg Enterprises d/b/a Quick Finance CO. Hematology and Oncology Clinic,Hattiesburg, MS Highland Community Hospital Hills High Tech Autobody and Refinishing Holden Earthmoving & Construction Hollywood Casino Home Instead Senior Care Honda of Slidell Home Town Lumber & Supply Hood Industries Inc. Hope Church employees who work in are paid or supervised from Hattiesburg, MS Hope Haven Hopkins & Associates, P.L.L.C. Hortsman Special Product Inc. Hospice House employees of Hospice House who work in Slidell Hubsouth Gastroenterology Clinic, Hattiesburg, MS HubCare Pathology, P.A., Hattiesburg, MS Hubsouth Medical Clinic,PLLC, Hattiesburg, MS Humana Military Healthcare Services Hyundai of Slidell Imperial Palace of Mississippi Industrial Corrosion Control, Inc. In'Finite Artsports Inc. International Game Technology International House of Pancakes #4484 International House of Pancakes/Gulfport Isle of Capri Casino J.L. DeLaughter Attorney Jackson Avenue Auto Sales Jackson County School District Jackson County Sheriff's Department - Employees of Jackson County Sheriff's Department who work in, or are paid or supervised from Pascagoula, MS. JAD, Inc. Janie's Pet Center Jason Pilger Huyndai Jazzeppi's Ristorante & Martini Bar JO Collins Contractors, Inc. Joe's Garage John C. Stennis Space Center John C. Stennis Space Center / Civilian Personnel John C. Stennis Chapter of the Air Force Association John J. McMullen Associates Johnson Controls Jones Companies LLC - Employees of Jones Companies LLC who work in, or are paid or supervised from Hattiesburg, MS. JW Puckett & Company K-9 Designs Productions LLC Keith Huber, Inc. Keith's Superstore, employees who work in, or paid or supervised from Hattiesburg, MS Keller Williams Realty Kennedy Engine Company, Inc. Key West Inn Kids Connection King's Custom Cabinets Knight Abbey Printers Knights Marine & Industrial Services Krewe of Diamondhead Lakeview Nursing Center Lakeview Regional Medical Center Lamar Advertising Lamar County, MS Lamar County, MS Sheriff's Department LAMAR COUNTY SCHOOL DISTRICT EMPLOYEES, STAFF, AND STUDENTS Lazy Magnolia Brewery- Employees of Lazy Magnolia Brewery who work in, or are paid or supervised from Kiln, MS. Lee's Hamburgers Inc. Employees who work in, or are paid or supervised from Slidell, LA. � Levis Chevrolet Cadillac Linda Hillman Allstate Linda's House of Fashion Liqui-Chem, Inc. Live Oak Village of Slidell Living Waters Medical Center Liz's Pet Sitting Service L.L. Kergosien & Son LoCoCo & LoCoCo Attorneys at Law Long Beach School District Louis D. Rash and Associates, LLC Loyalton Lyman Fish Hatchery MAC's Construction Company Inc. - Employees who work in, or are paid or supervised from Hattiesburg, MS Magnolia Framing and Art Gallery Mallette Brothers Construction Company Inc Magnolia Printing Mandal Pontiac Buick GMC Mandals Inc. Manheim Mississippi Manheim New Orleans - Employees of Manheim New Orleans who work in Slidell, LA Mario J. Roybal, DDS Marion General Hospital, Columbia, MS Mark Mitchell, Inc. McAlisters Deli McCarty Learning Center Mcdonalds/Ocean Spring,MS Medical Arts Pharmacy Members of record of Junior College Federal Credit Union MetLife Auto and Home Micro-Methods Laboratory Mississippi Board of Animal Health - Employees of Mississippi Board of Animal Health who work in Jackson, MS Mississippi Divison of Medicaid employees MS Dept. of Archives & History employees who work in paid or supervised from Jackson, MS MS Department of Environmental Quality who work in or are paid form Jackson, MS Mississippi Department of Transportation MS Dept of Wildlife Fisheries and Parks who work in or are paid form Jackson, MS Mississippi Department of Wildlife, Fisheries and Parks, Bureau of Marine Resources Mississippi Development Authority Mississippi Economic Council - Employees of Mississippi Economic Council who work in or are headquartered in Jackson, MS. Mississippi Emergency Management Agency (MEMA) who work in, or are paid or supervised from Pearl, MS Mississippi Farm Bureau Federation; Mississippi Farm Bureau Casualty Insurance Company; Southern Farm Bureau Life Insurance Company; Southern Farm Bureau Casualty Insurance Company; Mississippi Farm Bureau Service Company, Inc Mississippi Fire Academy Employees who work in, or are paid or supervised from Pearl, MS. Mississippi Forestry Commission - Employees of Mississippi Forestry Commission who work in or are paid or supervised from Jackson MS Mississippi Gaming Commission Mississippi Mosquito Control/Kiln Mississippi Mosquito Control/Pascagoula Mississippi Wildlife Federation Employees Mitchell Marine Mobile Jaycees Modus, Inc. Moor and Munger Moore and Powell, CPAs Moran, Seymour & Associates Mosaic Tapas Bar Moss Point School District employees and students MRG Management Resources Inc. MS Children's Home Services employees MS Children's Home Services MS Coast Coliseum & Convention Center MS Coast Restaurant and Beverage Association members and employees MS Dept of Finance MS Department of Marine Resources MS Gaming Commission MS Gulf Coast Community College Foundation, Perkinston, MS MS Gulf Coast YMCA / Ocean Springs MS Gulf Coast Youth for Christ MS Regional Housing Authority No VIII MS Security Police MS State Council of Machinists, Pascagoula MS STATE PERSONNEL BOARD EMPLOYEES WHO WORK IN OR ARE PAID OR SUPERVISED FROM JACKSON, MS Murphy and Associates, Attorneys at Law Natchez Trace Funeral Home and Memorial Park Cemetery Munn Enterprises Murphy Chiropractic Clinic Newton & Hoff, Attorneys at Law and Partners North Bay Family Medical Clinic Northshore Broadcasting, Inc. Northshore Food Bank - Employees and the Board of Directors of Northshore Food Bank who work in or are paid or supervised from Covington, LA. Northshore Technical Community College (NTCC) employees, staff and students Northwood Hills Animal Hospital Ocean Springs Record-Independent Ocean Springs School District Odyssey Healthcare Offender Watch employees who work in, or are paid or supervised from Covington, LA Omni Engineering Orkin Pest Control Owen & Galloway Law Firm Oxford Healthcare Employees Page, Mannino, Peresich & McDermott PLLC Palmer's Toyota Superstore - Employees of Palmer's Toyota Superstore who work in, or are paid or supervised from Mobile, AL Panter Chiropractic Clinic Parlin and Murphy Attorneys at Law Pass Road Baptist Pat Peck Nissan and Pat Peck Honda Paul J. Rouse, Jr. D.D.S., P.A. Pavco Industries Pearl River County Hospital & Nursing Home PFG Precision Optics, Inc. Piggly Wiggly Store # 602 - Employees of Piggly Wiggly Store # 602 who work in, or are paid or supervised from Wiggins, MS. Pines On The Bay Pizza Inn/Wiggins Plitz, Williams, LaRosa & Co., CPA Poole's Cable Service Inc. Power Shack Preston Hood Chevrolet Provision Living at Hattiesburg R. Ben Young & Associates R. Kimble Doty, Jr. D.D.S. R.F. Ederer Company Radich Heating, Air Conditioning & Refrigeration Ralph P. King II & Associates, PLLC Ramrock School Supplies Retired Officers Associaiton (ROA) Rex Distributing Company Rick LaCuesta, DDS Robert Dueitt Construction LLC Employees who work in, or are paid or supervised from Mobile AL Ronald S. Seymour, CPA, PA Rotolo Consultants Incorporated Roughwater Marine Roy Anderson Corporation Rushing & Guice Attorneys At Law SEC Leasing Company, Hattiesburg, MS S&F Publishing/ The Bay Press SAAD Enterprises Sam's Club Sartin's Discount Drugs & Sartin's Vital Care Science Applications International Corp (SAIC) Sea Coast Echo Sears Retail Dealer/Wiggins Sears Roebuck / Edgewater Mall Seemann Composites, Inc. Sharkheads Souvenir City Shaw's Fishhouse Sheila A. Smith / Hypnotherapist Sign Lite Simpkins & Costelli, Inc. Singing River Health System - Employees of Singing River Health System who work in or are paid or supervised from Gautier MS. Singing River Mall Slidell Memorial Hospital SMB Radiology Smith Brothers Collision Center , employees who work in or are paid or supervised from Hattiesburg, MS Smith Homes, Inc., Realtors Social Security Administration Social Security Disability Consultants Inc. South Mississippi Anesthesia Associates,P.A.,Hattiesburg, MS Sourth Mississippi Art Association - Employees and members of South Mississippi Art Association in Hattiesburg, MS who qualify for membership in accordance with its charter and bylaws in effect on 02/24/1993. South Mississippi Regional Center South Mississippi State Hospital, Purvis, MS Southeast Mississippi Rural Health Initiative Southeastern Door and Window Southern MS Planning & Development District, Inc. SouthernCare Southern View Media - Employees who work in, or are paid or supervised from Daphne, AL Specialized Treatment Facility Spherion Staffing/Gulfport Sprint PCS/Biloxi Sprint PCS/Gulfport Sprint/PCS/Pascagoula St. Martin School employees St. Martin School students grad 9-12 St. Peter The Apostle Catholic School St. Stanislaus St. Tammany Parish Sheriff's Department Stanley C. Dellenger Sheet Metal Works & Roofing STARC Sterling Petroleum- Employees of Sterling Petroleum who work in Harahan LA Sterling Surgical Hospital Stirling Properties Stokes Distributing Center Employees who work in, or are paid or supervised from Hattiesburg MS. Stone County Board of Supervisors Stone County Economic Development Partnership Stone County School District-Employees and Students Suburban Lodge Superior Optical Supreme Automotive Group Surgery Clinic of Hattiesburg Swetman Security Service Swiss Confectionery - Employees of Swiss Confectionery who work in New Orleans, LA. Syncom Space Services, employees who work in or are paid or supervised from New Orleans, LA (Michoud Assembly Facility) Tammany Supply Taylor Made Lawn Care Team One Communications-Pascagoula Technology, Management & Analysis Corp Temple Baptist Church Temple Christian Academy The Ad Group The Farese Group employees who work in or are paid or supervised from Ridgeland, MS The Family Practice/After Hours Clinic,PLLC,Hattiesburg, MS The Home Depot/Biloxi The Home Depot/Gulfport The National Guard of Mississippi - Employees and voting members of The National Guard of Mississippi located in Mississippi, who qualify for membership in accordance with its charter and by-laws in effect 4/30/2016. The Town of Pearl River, Louisiana The Insurance Center The New Palace Casino The Shoe Boutique Thomas M. Vickery, PE, PLS Tindall Corporation Town of Madison, MS Transportation Security Administration Travel Affiliates & Cruises Only Treasure Bay Casino Triad Broadcasting Trinity Hospice of Mississippi LLC, Hattiesburg, MS Triton Enterprises Turan-Foley US Border Patrol US Department of Interior, Fish & Wildlife US Department of Labor, Wage, & Hour US District Courts Southern District of MS US Forest Service, De Soto National Forest USDA Animal & Plant Health Inspection USDA Forest Service-Southern Reserach Station USM-Gulf Coast Research Laboratory V. Denise Lee Attorney V.T. Halter Marine, Inc Vergent LMS-Employees of Vergent LMS who work in, or are paid or supervised from Ridegeland, MS Veterans of Foreign Wars Post 3253 Vicari Auction Company LLC - Employees of Vicari Auction Company LLC who work in, or are paid or supervised from Harvey, LA WalMart/Wiggins Walter Anderson Museum of Art WAOY 91.7 Wellman Inc. Wendy's Wesley Health System, Hattiesburg MS West St. Tammany Parish Chamber of Commerce employees and members Whitestone Transportation,LLC Wild Bill's Foundations William Carey University Alumni Association Employees Williams Janitorial WKNN/WMJY FM WLBT Inc Employees who work in,, or are paid or supervised from Jackson MS Wingate by Windham employees who work in or are paid or supervised from Slidell, LA WLOX TV, Inc. Woolmarket Baptist Church WXXV Fox 25 WYES-TV/PBS - Employees of WYES-TV/PBS who work in, or are supervised from New Orleans, LA. Yates Construction Yellow Book, USA
You're logged in as