310313 04/18/17 CITY OF CARMEL, INDIANA VENDOR: 371447
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CHECK AMOUNT: $RRRRRRRR80.00•
ONE CIVIC SQUARE FBI NATIONAL ACADEMY CARMEL, INDIANA 46032 BLDG.8-102 CHECK NUMBER: 310313
QUANTICO VA 22135 CHECK DATE: 04/18/17
DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION
1110 4355300 80.00 ORGANIZATION & MEMBER
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National Office:
FBINAA, FBI Academy,Bldg.5-102
Quantico,VA 22135
46 F I NAA PH: 703-632-1944/FAX:703-632-1940
FBI National Academy Associates, Inc. I www.fbinaa.org
Thank you for Rejoining the FBINAAI Please complete this form so we may update our records and process your dues. Your
membership will be reactivated AFTER JAN 5,2017. Once reactivated, you will enjoy the following member's only benefits: on-line
bi-monthly issues of The Associate magazine, e-newsletters, members only access to online Directory & Store, exclusive discounts
with Alliance and Academic partners,and correspondence on local events from your chapter. Dues run annually--Jan-Dec.
Member#(if known): Session#: 2 i I
Membership Type: Additional Membership Options:(only if applies to you)
Active Membership(Sworn) ❑ Retired Membership ❑Dual(adding chapter) ❑Transfer to/from another chapter
"Last Name:
First Name: f—
Gyv-0 VI
Preferred Mailing Address: PXork Home
Home Street Address:
-City,State,Zip:
Country: US ft
A
Home Phone:
3/7- 716- le2 3
LL Agency Name:
/11C le
Agency Street Address:
LLI
3 Ci`v,c 5gya�i'
City,State,Zip:
01,r�,�/
Phone: Fax:
90
• Home Email:
• e!14
Work Email:
Chapter Name:
A/"C'A c,
DUES: 70
• Enter NATIONAL dues($70 Sworn;$35 Retired;$15 International) _ $
Q 1 •Enter your CHAPTER dues(contact Membership if unsure) + $10.00
TOTAL(National+Chapter): _ $ 90
FORM OF PAYMENT:
•Credit Card Payments:Fax form to 703-632-1940,email iwatson@fbinaa.orQ OR call 703-632-1944
with payment information.Credit info is not kept on file.
• •Check Payments:Make checks payable to FBINAA.Mail directly to: FBINAA,FBI Academy,Bldg.8-
102,Quantico,VA 22135
Payment Method Check Credit Card(VISA,MASTERCARD,AMEX,DIS)
Card Number: Exp: _/ CVC:
Name as it appears on card: