Raleigh Claims Association 2009 Application for ASSOCIATE Membership ASSOCIATE MEMBERSHIP may be granted to any person upon application and payment of dues provided such person meets any one of the following descriptions:   inspires and inculcates, by proper education and the dissemination of information, a deeper interest in   the study of adjusting and related activities;   provides and encourages adherence to a code of ethics for those engaging in the business of adjusting   and related activities; or   is engaged in a business that directly services the work function performed by regular members. Any applicant for Associate Membership may be rejected with or without cause by the Board of Directors. Associate Members are entitled to all the rights and privileges of the Association with the exception of voting and holding office. Date: ___________________________________ Please print legibly! If you cannot print legibly, please type or attach a business card. Application for Associate Membership must be submitted for approval annually. Name: _________________________________________________________________________________________ License(s) Held, if any: ___________________________________________________________________________ All meeting notices sent throughout the year are sent only via email. Please indicate whether you prefer: __ Home Email Address _______________________ ---___ Work Email Address___________________________ Job Title: __________________________________________________________________________________ Employer/Company Name: ____________________________________________________________________ Company Mailing Address: ____________________________________________________________________ Work Telephone: ____________________________________________________________________________ Home Address: ______________________________________________________________________________ Home Telephone: ____________________________________________________________________________ Cell Phone: _________________________________________________________________________________ Are you a member of any other local claims associations? ___yes ___no   If yes, name(s) of associations: _______________________________________________________ Are you interested in sponsoring any events? __yes __no __not sure, please have someone contact me Are you interested in sponsoring any meetings? __yes __no __not sure, please have someone contact me Are you interested in helping with events such as the Golf Outing, Christmas Party, etc., either with advance   planning or on-site the day of the event? __yes __no __not sure, please have someone contact me Please send your $20.00 membership dues to: Raleigh Claims Association P.O. Box 10183 Raleigh, NC 27605-0183 _______________________________ For Board Use Only: Date Received__________________ Amount_______________________ Receipt Sent:___________________ Email Verified on Membership List____________________ Board Review___________________________ Date Approved/Rejected___________________