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CBIA Membership Application / Transfer Notice

For Calendar Year
January 1, 2014 through December 31, 2014
Annual Dues: $60 per person

Applicant Title / Rank
Agency Division
Agency Address Agency City
Agency ZIP Code Agency FAX
Agency Phone Extension
Your E-Mail POST ID#

Applying for: (Check Type of Membership)

   Representative Membership

For those employed full or part time as active or retired California sworn peace officers, and who are assigned to perform, administer or directly supervise persons performing pre-employment background investigations for California State or Local agencies authorized by law to employ peace officers.

   Associate Membership

For past Representative Members in good standing; non-sworn persons employed by a Member Agency to perform pre-employment background investigations; non-sworn personnel employed to provide essential information for assessing the qualifications of peace officer applicants in a Member Agency; persons employed to perform pre-employment background investigations in other public sector agencies; persons employed to perform Federal pre-employment background investigations.

   Transfer of Membership Only

A member in good standing may assign their membership for the remainder of the PAID membership year, (Jan.1 - Dec.31), to a person qualified for the Association membership, and who is employed by the same employer.

Transfer to: "New Name"    

Transferred by Member      

Additional Information you deem necessary
If you are a private investigation agency please tell us what public safety
agencies you contract with and provide a contact name and telephone number.


I acknowledge that by completing this form, all facts are true and that I will mail the dues of $60.00 for membership as a Representative or Associate Member to the following address:

NOTE: Annual dues are $60 per person; Membership covers from Jan. 1 to Dec. 31 of the calendar year. CBIA accepts checks, money orders and credit cards (VISA/MC only). Credit card transactions are processed using Citizens Bank ~ VeriFone, Inc./PCCharge-Pro software; receipts will be mailed; checks are manually deposited and your cancelled check is your receipt.

Attn: Membership
P.O. Box 2127
Yorba Linda, CA 92885-1327

Fax / Voice Mail


NOTE: Make checks payable to "CBIA"