I hereby make an application for membership (or renewal) in accordance with NYS IAAI Constitution and By-Laws and agree to be bound therewith.
First Name:
Last Name:
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You will receive mail from us at this address. Pick type:
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Best Address:
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Zip:
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Pick one:
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Gender:
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Enter the 4 digit year of your birth
Your title:
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Home
Mobile
Other
Work
Business or Other email:
Supervisor Name
Supervisor Contact
Affiliation
Type of Department
Have you ever been convicted of a crime, felony, or misdemeanor? Note: A yes answer to this question may affect your acceptance as a member of the NYS IAAI
If no, type NO. If yes, explain offense, particulars, and disposition
Have you ever been denied membership in, or had your membership suspended, or revoked by the IAAI, any affiliate Chapter, or any other fire service, law enforcement or other professional organization? Note: A yes answer to this question may affect your acceptance as a member of the NYS IAAI
If no, type NO. If yes, please explain
Completion of Application
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By submitting this application you affirm that all information presented is correct and accurate with no errors or omissions; you understand membership is contingent upon successful completion of a vetting process. If you are not contacted, no further action is required.