I hereby make appplication for active membership in the Central Illinois
Fire Investigators Association in accordance with its constitution and
by-laws, and agree to be bound therewith.  I am transmitting $10.00 with
this application for annual dues.  All information given by me is
warranted to be true.

PLEASE PRINT OR TYPE:

1. Name ____________________________________________________________ 2. Date of Birth ______________
        (Last)                         (First)                 (MI)

3. Home Address ____________________________________________________________________________________

4. City ________________________________________________ 5. State _______ 6. Zip ___________________

7. Home Phone (      ) __________________ 8. E-mail Address ________________________________________

9. Employed By __________________________________ 10. Business of employer _________________________

11. In What Capacity ______________________________________ 12. How Long ___________________________

13. Business Address _________________________________________ 14. Phone (      ) __________________

15. City _______________________________________________ 16. State ______ 17. Zip __________________

18. Send Mail To: (check one) Business Address _____   Home Address _____

19. State Your Qualifications for Membership: ______________________________________________________

____________________________________________________________________________________________________

____________________________________________________________________________________________________

20. References: (name, address, phone number, and occupation of each)

A. _________________________________________________________________________________________________

B. _________________________________________________________________________________________________

C. _________________________________________________________________________________________________

21.  Applying for (   ) Active Membership   (   ) Associate Membership
NOTE:  Applicants residing outside the boundaries of the Association are eligible for associate 
membership only.  The boundaries are the same as those of the Illinois Chapter I.A.A.I., Central Zone.

Recommended By Member In Good Standing:                  Applicant's Signature:

Signature _____________________________________               ______________________________________

Date __________________________________________          Date ______________________________________



Date Application Received ___________________              Application Approved (  )  Rejected (  )

Membership Chairman ___________________________________________________________ Date _______________