CBIA Membership Application

Membership Application / Transfer Notice
Calendar Year
January 1, 2008 through December 31, 2008

Applicant:
Title/Rank:
Agency:
Division:
Agency Address:
Agency City:
Agency ZIP Code:
Agency Phone:
Extension:
Agency Fax:
Your E-Mail:

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 $45.00 for membership as a Representative or Associate Member to the following address:

NOTE: 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.

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

Fax / Voice Mail
714.524.6360

E-Mail: vfoster@ci.garden-grove.ca.us

NOTE: Make checks payable to "CBIA"

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