Detailed Information |
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First Name: |
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Last Name: |
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Company: |
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Title: |
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Job Responsibility: |
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How did you hear about IAFCI? (check all that apply) * |
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Why did you choose to join IAFCI? (check all that apply) |
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Once a member of the IAFCI, do you plan to join any of our sponsored Industry Groups? |
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View Industry Group Information Here
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If you are applying as a two for one, please enter name of co-applicant. (both applicants need to apply): |
Co-Applicant Name: | |
If you are replacing a IAFCI member, please enter name: |
Replacement Name: | |
Have you ever been an IAFCI Member before?
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Have you ever been convicted of a crime other than a minor traffic violation?
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I am applying for membership in IAFCI under the following classification:(Member Type)
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Classification: |
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I am applying for membership in IAFCI in the following chapter:
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Chapter: |
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Business Contact Information is Required |
Address: |
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State: |
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Phone: |
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Email: |
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Misc Information |
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Agreements |
Authorization Agreement: |
I have read the qualifications for membership. I hereby authorize agents of the
IAFCI Membership committee to conduct necessary investigation, in compliance with
National and Local Law, on my application (or I agree to provide the necessary
information) to verify my background and business licensing to determine my eligibility
for membership, and to report to the Committee accordingly.
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Confidentiality Agreement: |
I understand that as a member of IAFCI I may from time to time receive information
of a sensitive and confidential nature. Specifically, information gathered through
the IAFCI Network and Website is sensitive and shall remain confidential. I agree
to preserve the confidentiality of all information obtained through the IAFCI and
not to disclose it to anyone except within the confines of my employment duties
and responsibilities.
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