APPLICATION Brainerd

A PPL IC AT ION † New

Please check one:

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First Name

M.I.

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City

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Company Name

 

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!

State

Zip

______________________________________________

_______________________

____________________

City

Gender

Birth Date (mm/dd/yy)

State

Zip

( ____ ) ____________________

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( ____ ) ________________ ( ____ ) _______________  





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I would like an IAAP member pin:

† No

Preferred mail to: † Home  !" † Home

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■ Check here if you do NOT wish to receive IAAP Partners mail. †

† !
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 %& & ' '* '' + , +! ' &- +NOT wish  -!  *  ' ', #+,  #  +  +- +3 ,

How did you hear about IAAP?

† Colleague † A sponsor/vendor † My employer/manager

† Google/Internet Search † I attended an IAAP event † IAAP homepage

Type Of Membership

†
  † I attended a local chapter/division meeting

Select the membership option that best serves your needs

Select One

Type

!

!!"


  ! # 
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Chapter Dues

Division Dues

 *

Total

†

Professional

+ $88

+ $_____

10 + $_____

15 + $_____

$15

128 = $_____

†

Associate

+ $180

+ $_____

NA

NA

$15

195 = $_____

Dues for members of the association include $25 for a subscription to
 which may not be deducted from total dues. Membership dues are nonrefundable.
              

Brainerd

324100 ____________________________________________________________________________________________ ________________________________ Name of IAAP Chapter Chapter No. ____________________________________________________________________________________________ ________________________________ Recruited By Recruiter ID No.

Method Of Payment Would you like to make a donation to The Foundation of IAAP? Total Enclosed in U.S. dollars

† Yes

(total from membership type plus optional donation)

† $5 † $10

… Visa

… MasterCard

… Discover

ID ____________________________________________ Chapter No. ____________________________________

___________________ Expiration Date

Total Paid $ ____________________________________

_________________________________________________________________________ Name as it appears on card

Processing $ _________ IAAP Dues $ _____________ Chapter $ ____________ Division $ ________________

_________________________________________________________________________ Authorization Signature (required for processing)

MAIL TO: IAAP

l

_________

Headquarters Use Only

… American Express

___________________________________________________ Card Number

† Other

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… Check or Money Order Number _________________________________________ Credit Card:

† $25

10502 N Ambassador Drive, Suite #100

Bill/Refund ___________ Prepay Amount $_________

l

Kansas City, MO 64153-1291

816-891-6600 l Fax: 816-891-9118 l E-mail: [email protected] l Website: www.iaap-hq.org

Membership

in IAAP gives
  
   
    
 membership.

Enhancing the success of career-

Professional: 


 
    
    

           
   !  

minded administrative

Associate:   "        !#%& business or institution provides one contact person per associate membership.

professionals by

&   !#'      " www.iaap-hq.org/aboutus and click “Chapter Locator” on the right. Or e-mail [email protected].

providing opportunities


#
 * ‹ 6MÄJL7YVMagazine , Access to IAAP’s Web Community , Discounts on Training, Education and Conferences , Leadership Development , Online Resources , 2 3' ,     4   , 6  

for growth through education, community building and leadership development. -IAAP Mission Statement

         

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    ;!     # www.iaap-hq.org/join.