APPLICATION

AP P L I C A T I ON
__________________________________________________________________
First Name
Middle Initial Last Name
(_________ )________________________________________________________
Office Phone
__________________________________________________________________
Job Title
(_________ )________________________________________________________
Home Phone
__________________________________________________________________
Email Address
(_________ )________________________________________________________
Mobile Phone
o Email Opt-Out
We want to stay in touch with you regarding IAAP information, benefits, and
educational offerings. However, if you do NOT wish to receive emails from
IAAP regarding membership, member promotions, conferences, education and
events, check this box.
Preferred daytime phone:
Preferred mail to:
_____________ Gender (optional)
__________________________________________________________________
Home Address/PO Box
Age range (optional)
o 25 & Under o 26-35 o 36-45 o 46-55 o 56 & Up
o Office
o Home
o Office
o Home
o Cell
__________________________________________________________________
Company Name
__________________________________________________________________
Home City
State
ZIP
Country
__________________________________________________________________
Office Address/PO Box
o Check here if you do NOT wish to receive IAAP Partners mail.
__________________________________________________________________
Office City
State
ZIP
Country
Type Of Membership
Select the membership option that best serves your needs
Select One
Type
Annual IAAP Dues
Optional Air Mail for OfficePro $27*
Total
o
Professional
$141
+ $_____
= $_____
o
Student**
$51
+ $_____
= $_____
How did you hear about IAAP?
o Social media
o Colleague
o Google/Internet Search
o OfficePro
o Sponsor/Vendor
o I attended an IAAP event
o Employer/Manager
o IAAP homepage
Dues for members of the association include $25 for a subscription to OfficePro which may not be deducted from total dues.
Membership dues are nonrefundable.
*Optional airmail is for members outside the United States, Canada, U.S. territories, Puerto Rico, Virgin Islands.
**Students must include verification from their educational institution of being in a degree-granting program, with an anticipated graduation date.
____________________________________________________________________________________________
Name of Recruiter
Method Of Payment
_________________________________________________
Recruiter ID No.
Would you like to make a donation to The Foundation of IAAP? o Yes
IAAP annual membership dues for professional
members can be paid in three types of installment
options: Annually ($141); semi-annually ($74 payable
twice per year for a total of $148); quarterly ($39
payable four times per year for a total of $156)
First installments of the payment plan options are due
on join or renewal date. Non-payment of an installment
payment will result in membership lapse and removal
of membership benefits. IAAP membership fees are
non-refundable and renewed annually.
o $5
o $10
o $25
o Other_____________
Total Enclosed in U.S. dollars (total from membership type plus optional donation)_____________________________________
q Check or Money Order Number____________________________________________________________________________
Credit Card:
q Visa
q MasterCard
q Discover
q American Express
Card Number_________________________________________
Expiration Date__________________
SEC Code__________
Name as it appears on card__________________________________________________________________________________
Billing Address______________________________________________________________________________________________
City___________________________________________________
State/Prov________________
ZIP/PC__________________
Authorized Signature (required for processing)___________________________________________________________________
By completing this application, I agree to accept and abide by the IAAP Code of Conduct.
MAIL TO: IAAP l 10502 N Ambassador Drive, Suite #100 l Kansas City, MO 64153-1291
816-891-6600 l Email: [email protected] l Website: www.iaap-hq.org