Membership Renewal

$20.00

Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Phone
Cell Phone
Fax
Date of Birth*
Date Format: MM slash DD slash YYYY
Email*
Enter Email Confirm Email
Department / Agency You're Representing:
Department / Agency Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mailing Address*
- Home
- Business
Present occupation or position:
Are you a member of the I.A.A.I.?
- Yes
- No
If yes, Member No.:
By payment of a KS IAAI membership renewal invoice, the member affirmatively represents that he or she has not been convicted of any crime nor has their candidacy for KS IAAI membership changed in any way that would have denied them membership when they first applied. The member affirmatively represents that they have not violated the KS IAAI Constitution and ByLaws or Code of Ethics since they first applied. If the member believes they are in violation of the above then they must fully disclose in writing the circumstances of such violation to the KS IAAI Board within 30 days of this notice. As a result of any such violations, the member’s membership status may be jeopardized because the member’s eligibility for membership has changed in a way that would have denied him/her initial membership. “I do hereby make renewal application for membership into the Kansas Chapter of the International Association of Arson Investigators, in accordance with the Constitution and ByLaws, and I agree to be bound therewith. I am transmitting $20.00 for annual dues with this form.”
Signed*
Date Submitted*
Date Format: MM slash DD slash YYYY