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					                                                                                                           IIA/Bank Use Only
                      Membership Application
          The Institute of Internal Auditors
IIA Membership Number ______________________________

IIA Chapter Number _________________________________

    1.     Business Data
Please Type or Print Clearly

    ___ Mr.            ___Mrs.               ___Ms.                 ___Other

Name_________________________________________________________________________________________________________________________ _____
                            (Last)                                       (First)               (Middle)                       (Nickname)

Organization: ____________________________________________________________ Job Title: ___________________________________________________

Address: ____________________________________________________________________________________________________________________ _______

City: ___________________________________________________________ State/Province: _______________________________________________________

ZIP/Mail Code: _______________________________________________________ Country: _____________________________________________ __________

Business Phone: _________________________________________________ Business FAX: ________________________________________________________
Job Code (see attached listings): ____________________________________ Industry Code(s): ___(1)________________________(2)___ _____________________

Email: ______________________________________________________________ Number of internal auditors on staff: _________________ _________________

    2.     Personal Data                                                                Check here, if you do not wish your name included on mailing
Home Address:
_____________________________________________________________                        lists other than membership mailings.
                                                                                        Check here, if you do not wish your e-mail address used for IIA
City: __________________________ State/Province: __________________                  communications.
ZIP/Mail Code: ___________________________ Country: ______________
                                                                                         4.      Dues and Payment
Home Phone: __________________________________________________                       See dues payment information next page.
Have you ever been convicted of a felony?                ___ Yes    ___ No                                 Application Fee                 $ _____________
Are you a Certified Internal Auditor?                    ___ Yes    ___ No                                                    Dues         $ _____________
Other Designations: _____________________________________________                                Seminar conference/credit                 $(_____________)
Send Mail to:          ___ Home Address                  ___ Business Address             For checks drawn on banks outside
                                                                                                    the US and Canada, add
                                                                                                 $30 bank collection charge.               $ _____________
                                                                                                        TOTAL AMOUNT                       $______________
    3.     Membership Data                                                           Check One:
Please select appropriate membership classification (see inside for classification   ___ Payment enclosed. Please make checks payable to The
descriptions). Classification is subject to determination by the International           Institute of Internal Auditors
Membership Committee.                                                                ___ Charge to my (circle one):
    Member                 Educational Member                Life Member                      MasterCard           VISA                    American Express
    Student Member. If applying as a student member, please give the name of
                                                                                     Card No: _____________________ Expiration Date: _______
the college or university you attend:
Date of Graduation:
                                                                                     Signature:__________________________________________
Degree:
Chapter Affiliation Desired (If known. See back page):

                                                                                         5.      Applicant’s Signature
Membership Sponsor (optional):
                                                                                     I declare that:
Sponsor Member No.:
                                                                                       1. All information contained on this application is true and correct.
Special Membership Sections – Open to all IIA members. If interested, select           2. If accepted, I agree to abide by the Code of Ethics adopted by The
the specialty membership section you would like to join:                                  Institute of Internal Auditors to govern its members.
    Gaming Audit Group – For individuals involved with casinos, lotteries,
racetracks, other gaming enterprises, and government                                 Applicant’s Signature: ___________________________________________
regulatory commissions or agencies.                                                                                            Date: ____________________

    Control Self-Assessment Center – For individuals interested or involved
in Control Self-Assessment.
    CAE Services Program – For chief audit executives.

                            See Reverse Side for Fees
                     Membership Classifications                                                      Seminar/Conference Credit
Please check appropriate membership classification under Membership             Anyone who has attended an IIA headquarters-sponsored seminar or
Data on front page.                                                             conference and paid the nonmember price may apply for a free first-year
                                                                                membership in The Institute within 90 days of attending the program. A
Member – Open to individuals involved in internal auditing, internal            special application form is provided for this purpose upon completion of the
controls, risk assessment, information systems auditing, and related fields.    seminar or conference. If the application is not available, please complete the
Also those who have an interest in internal auditing, e.g., members of          information below and indicate membership credit under Dues and Payment
                                                                                information on front page. No application fee is necessary.
Audit Committees, external public accountants, controllers, CEOs, and
suppliers of services.                                                          Seminar or Conference Title: ________________________________

Educational Member – Individuals principally employed as                        Date: __________________ Location: ________________________
educators at colleges.
                                                                                Amount of Discount:           $ _________________________________
Student Member – Those engaged full time in the study of internal
auditing or related courses at colleges and universities who cannot qualify
as a Member or Educational Member. (Will receive Internal Auditor, but                               Dues Payment Information
not AuditWire)
                                                                                In the United States and Canada: *
                                                                                Application fee of $25 and appropriate dues for year of admittance
Member – International – Members, Educational Members, and Student
                                                                                (payable in US funds) must accompany this application.
Members outside the U.S. and Canada.
                                                                                Member…………………….. .......................................... $110
Special Membership Sections – Open to all IIA members.
                                                                                Associate Member ............………………………………$110
The IIA is responsive to the specialized needs of its members through
                                                                                Educational Member .......………………………………$ 60
several special membership sections:
                                                                                Student Member…………. ............................................. .$ 30
                                                                                  (Student need not pay application fee.)
Gaming Audit Group – For individuals involved with casinos, lotteries,
                                                                                Life……………………………………………………….$2100
racetracks, other gaming enterprises, and government regulatory
commissions or agencies. The Gaming Audit Group offers a quarterly              Special Membership Sections (Note dues are in addition to IIA
newsletter, exclusive on-line forum, membership directory, and annual           membership):
conference.                                                                       Gaming Audit Group…………………………………$ 40
Yearly dues: $40 in addition to IIA membership.                                   Control Self-Assessment Center……………………..$ 40
Control Self-Assessment Center – Provides networking for                          CAE Services Program……………………………….$100
individuals involved in CSA and brings together in one area IIA                 General Dues Information:
guidance, publications, seminars and conferences on CSA                          Dues are billed yearly on the anniversary date of membership.
implementation. The CSA Center offers a tri-annual newsletter, a                 Dues are tax deductible (U.S. members).
membership directory, exclusive on-line forum, certification, and                Dues and application fees are subject to change at any time by the
annual conference.                                                                Board of Directors of The IIA.
Yearly dues: $40 in addition to IIA membership.                                  Annual dues include $40 fee for Internal Auditor and $15 fee for other
CAE Services Program – For chief audit executives to keep you                     professional periodicals. These fees cannot be deducted from the dues.
informed on IIA initiatives, issues, and activities through e-mail bulletins,   *Members-at-Large outside the United States and Canada:
periodicals, teleconferencing forums, special round-                            Dues of $110 plus $25 application fee. For drafts drawn on banks located
tables and discounts, CAE contact list, and IIA hot-line access. Yearly         outside the US and Canada, please add $30 to your payment to cover bank
dues: $100 in addition to IIA membership.                                       collection charges. Information regarding dues for chapters outside the United
                                                                                States and Canada is furnished upon request.

                                                         Return Completed Application to:
Affiliate Address:                                                                                    OR TO: The Institute of Internal Auditors
                                                                                                             PO Box 281196
                                                                                                             Atlanta, GA 30384-1196, USA


                                                               Need More Information?
               Contact The IIA's Service Center: E-mail: custserv@theiia.org . FAX +1-407-831-5171 . Tel: +1-407-830-7600, Ext. 1


                                   APPLICANT: PLEASE DO NOT WRITE BELOW THIS LINE.

FOR AFFILIATE (Chapter or National Institute)
Date Received: ____________________ Recommended Class of Membership: ________________________________________________________ ___
Affiliate Name and Number: ___________________________________________________________________________________________________
For Affiliate Board of Governors: ___________________________________________________            ____________________________________ ______
                                   (Signature)                                                      (Date)
FOR INSTITUTE OFFICE:
Approved: Manager of Membership Services             Date ___________________________________________________________________________
                                                   IIA Chapters//National Institutes
ALGERIA                               Riyadh                                      Fort Wayne                  North Dakota
ARGENTINA**                        SENEGAL                                        Indianapolis                     Central NoDak
AUSTRALIA**                        SINGAPORE**                                    Michiana (South Bend)       Ohio
AUSTRIA**                          SOUTH AFRICA**                          Iowa                                    Central Ohio (Columbus)
AZERBAIJAN                         SPAIN**                                     Heartland - Iowa                    Cincinnati
BAHAMAS                            SWEDEN**                                    Central Iowa (Des                   Dayton
BELGIUM**                          SWITZERLAND**                               Moines)                             Northeast Ohio (Akron,
BOLIVIA                            TAIWAN                                      Quad Cities (Davenport)             Canton, Cleveland)
         Cochabamba                THAILAND**                              Kansas                                  Toledo
         La Paz                    THE NETHERLANDS**                           Kansas City                    Oklahoma
         Santa Cruz                TRINIDAD & TOBAGO                           Topeka                              Oklahoma City
         Sucre                     TUNISIA                                     Wichita                             Tulsa
BOTSWANA                           TURKEY                                  Kentucky                           Oregon
BRAZIL**                           UGANDA                                      Central Kentucky                    Portland
CANADA                             UNITED ARAB EMIRATES                        (Lexington)                         Salem
         Alberta                      Dubai                                    Louisville (Frankfort)         Pennsylvania
         Calgary                   UNITED KINGDOM & IRELAND**                  South Central Kentucky*             Central Penn (Lancaster)
         Edmonton                  UNITED STATES                           Louisiana                               Lehigh Valley (Allentown)
   British Columbia                      Alabama                               Ark-La-Tex (Shreveport)             Northeastern Penn
         Vancouver                             Birmingham                      Baton Rouge                         (Scranton)
   Manitoba                                    Mobile                          Monroe                              Philadelphia
         Winnipeg                              Montgomery                      New Orleans                         Pittsburgh
   Newfoundland                                North Alabama               Maine                              Puerto Rico
         Newfoundland & Labrador         Alaska                                Downeast Maine                      Puerto Rico (San Juan)
   Nova Scotia                           Arizona                               (Portland)                     Rhode Island
         Maritime                              Phoenix                         Northeast Assoc./                   Ocean State
   Ontario                                     Tucson                          Downeast Maine                 South Carolina
         London (ON)                     Arkansas                              (Bangor)*                           Coastal Carolina
         Ottawa                                Ark-La-Tex                  Maryland                                (Charleston)
         Toronto                               Central Arkansas                Baltimore                           Palmetto (Columbia)
   Quebec                                      North Arkansas              Massachusetts                           Western Carolinas
         Montreal                        California                            Greater Boston                      (Greenville)
         Quebec City                           Beach Cities (Torrance)         (Worcester)                    South Dakota
   Saskatchewan                                Central Valley (Fresno)         Southern New England                Sioux Falls
         Saskatchewan (Regina)                 Channel Islands*                (Springfield)                  Tennessee
CHILE                                          (Ventura)                   Michigan                                Chattanooga Area
CHINA, PEOPLE’S REPUBLIC                       Inland Empire (San              Detroit                             East Tennessee
OF**                                           Bernardino)                     Lansing                             (Knoxville)
COLOMBIA                                       Los Angeles                     Michiana (Benton Harbor)            Memphis
   Bogota                                      Orange County                   Western Michigan (Grand             Nashville
CONGO, DEMOCRATIC                              Sacramento                      Rapids)                             Tri-Cities*
REPUBLIC OF THE                                San Diego                   Minnesota                          Texas
   Kinshasa                                    San Fernando Valley             Lake Superior (Duluth)              Abilene
COSTA RICA                                     San Francisco                   Twin Cities (St. Paul,              Ark-La-Tex
CYPRUS                                         San Gabriel Valley              Minneapolis)                        Austin
CZECH REPUBLIC                                 San Jose (San Carlos,       Mississippi                             Dallas
DENMARK                                        Santa Cruz, Santa Clara)        Central Mississippi                 El Paso
DOMINICAN REPUBLIC**                           Tri-Valley (Dublin)             (Jackson)                           Fort Worth
ECUADOR                                  Colorado                              Mississippi Gulf Coast              Houston
   Quito                                       Denver                          (Biloxi)                            San Antonio
EL SALVADOR                              Connecticut                       Missouri                           Utah
ETHIOPIA                                       Southern New England            Central Missouri                    Salt Lake City (Provo)
FIJI                                           (Hartford)                      (Jefferson City)               Vermont
FINLAND**                                      Westchester-Fairfield           Kansas City                         Green Mountain
FRANCE**                                       (Greenwich, Stamford)           Ozarks (Springfield)                (Montpelier)
GERMANY**                                Delaware                              St. Louis                      Virginia
GHANA                                          Philadelphia (Wilmington)   Nebraska                                Central Virginia
GREECE                                   District of Columbia                  Ak-Sar-Ben (Lincoln,                (Richmond)
GUAM                                           Washington, DC                  Omaha)                              Northern Virginia
   U.S. Pacific (Okinawa)                Florida                           Nevada                                  (McLean)
GUATEMALA                                      Central Florida (Orlando)       Las Vegas                           Southwest Virginia
HONG KONG                                      Florida West Coast              Northern Nevada (Reno)              (Roanoke)
HUNGARY                                        (Tampa)                     New Hampshire                           Tidewater (Norfolk)
INDIA**                                        Miami                           Granite State                       Triad (Southern Virginia)
INDONESIA                                      Northeast Florida               (Manchester)                        Tri-Cities (Big Stone
ISRAEL**                                       (Jacksonville)              New Jersey                              Gap)*
ITALY**                                        Northwest Florida               Atlantic City                  Washington
JAMAICA                                        (Pensacola)                     Central Jersey (Trenton)            Nisqually (Tacoma)
JAPAN**                                        Palm Beach County               North Jersey                        Puget Sound (Seattle)
KOREA, REPUBLIC OF                             Southwest Florida (Ft.          (Newark,West Caldwell,              Mid-Columbia (Richland)
LATVIA                                         Myers)                          Hackensack)                         Spokane
LUXEMBOURG                                     Tallahassee                 New Mexico                         Wisconsin
MALAWI                                   Georgia                               Albuquerque                         Central Wisconsin
MALAYSIA**                                     Atlanta                         Santa Fe                            (Stevens Point)
MEXICO**                                       Coastal Georgia             New York                                Madison
MOROCCO                                        Columbus                        Albany                              Milwaukee
NEW ZEALAND**                            Hawaii                                Central New York               Wyoming
NICARAGUA                                      Hawaii                          (Syracuse)                          Rocky Mountain
NORWAY**                                 Idaho                                 Long Island                         Cheyenne
PAKISTAN                                       Boise                           New York                   URUGUAY**
   Karachi                               Illinois                              Rochester                  VENEZUELA
   Pakistan                                    Central Illinois                Westchester-Fairfield          Caracas
PANAMA                                         (Peoria, Bloomington)           (White Plains)             ZAMBIA
PERU**                                         Chicago                         Western New York           ZIMBABWE
PHILIPPINES**                                  Chicago-West                    (Buffalo)
POLAND                                         Illiana                     North Carolina                 **        National Institutes
PORTUGAL                                       Northwest Metro Chicago         Charlotte Area
SAUDI ARABIA                                   Springfield                     Raleigh-Durham
   Dhahran                               Indiana                               Triad (Greensboro)
                                                          INDUSTRY CODES
Agriculture, Forestry, & Fisheries                                         Wholesale & Retail Trade
0100    Agricultural, forestry, fisheries, production/services             5000   Wholesale trade
                                                                           5300   Retail trade
Mining                                                                     5800   Eating and drinking places
1000   Mining
1300   Oil & Gas Extraction                                                Financial, Insurance, & Real Estate
                                                                           6000    Banking & financial institutions
Contract Construction                                                      6030    Nonbanking bank services (e.g., leasing)
1500   Construction                                                        6040    Thrift and savings & loan organizations
                                                                           6100    Credit unions
Manufacturing                                                              6130    Other credit agencies
2000  Food/kindred products                                                6200    Security and commodity services
2100  Tobacco manufacturers                                                6300    Insurance carriers, agents, services
2200  Textile mill products/apparel                                        6500    Real estate services
2400  Lumber/wood products (incl. furniture/fixtures)                      6700    Holding/investment companies
2600  Paper & allied products (incl. printing/publishing)
2800  Chemicals                                                            Services
2830  Drugs and research                                                   7000     Hotels/lodging services
2840  Petroleum refining and related industries                            7200     Personal/social services
3010  Rubber and plastics products                                         7300     Contracted audit services
3100  Leather, stone and glass products                                    7310     Management consultants
3300  Primary metal industries                                             7320     Information technology services
3400  Fabricated metal products                                            7330     Executive placement services
      (including non-electric machinery)                                   7500     Repair services
3500  Industrial and commercial machinery                                  7600     Gaming/lottery
3510  Aerospace                                                            7800     Motion pictures/amusement & recreational services
3520  Computers and related devices/equipment                              8000     Health services
3600  Electrical machinery, electronic equipment & supplies                8100     Legal services
3700  Transportation equipment                                             8200     Educational services
3800  Scientific, photographic, medical goods                              8600     Membership organizations
3900  Miscellaneous manufacturing industries                               8900     Public accounting/accounting/bookkeeping services
                                                                           8910     Miscellaneous services
Transportation, Communications & Utility Services
4000   Land transportation                                                 Government
4400   Water transportation                                                9100  Federal/national government
4500   Air transportation                                                  9200  State/provincial government
4700   Other transportation services                                       9300  Local government
4800   Communication services                                              9400  International government
4810   Telecommunications
4900   Electric/gas/sanitary services                                      Nonclassifiable
4910   Gas services                                                        9900    Nonclassifiable establishments
4920   Gas and electric services
4930   Sanitary services


                                                                 JOB CODES
Select the position that best describes your role and function (not necessarily your exact title) in your organization. Enter the appropriate
number in the job code section of the application.
                                                                            275 Audit Services Contractor — I offer internal audit
200 Chief Auditing Executive — I am the most senior                                 services on a contracted basis.
        auditing officer for the organization with ultimate
        responsibility for the entire internal auditing function.           280 External Public Accountant — I am a practicing public
210 Director of Auditing — I am the chief auditor                                   accountant, chartered accountant, etc.
        authorized to direct a broad, comprehensive program of              300 Corporate Management — I am a corporate officer,
        internal auditing within my organization.                                   CFO, CIO, CEO (and do not qualify under another job
220 Auditing Manager — I administer the internal auditing                           code above).
        activity of an assigned location within the general                 310 Educator — I am principally employed as an educator at
        guidelines provided by the director of auditing.                            a college or university (PhD., DBA, EdD., etc.).
230 Auditing Staff — I conduct, or assist in conducting,                    320 Student — I am pursuing a degreed program at a college
        reviews of assigned organizational and functional                           or university (including doctoral candidates) on a full-
        activities.                                                                 time basis.
245 IT Auditing Director – I am head of the IT auditing                     330 Retired — I am retired from active employment
        activity within my organization.                                            (otherwise refer to another job code).
250 IT Auditing Manager — I administer the IT auditing                      340 Audit Committee Member — I am an audit committee
        activity of an assigned location within the general                         member of a corporate board of directors (and do not
        guidelines provided by the director of auditing.                            qualify under another job code above).
260 IT Auditing Staff — I conduct, or assist in conducting,                 350 Management Consultant — I am primarily an
        reviews of assigned organizational and functional                           independent consultant with an interest in internal
        activities related to IT auditing.                                          auditing (otherwise refer to another job code).
                                                                            360 Other — Specify title or job description.

				
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Description: Real Estate Listings Stevens Point Wisconsin document sample