LICFE APPLICATION

P.O. Box 1173, Bethpage, NY 11714
Phone: 516-803-2607•Fax: 516-495-8761

E-mail: info@licfe.org Internet: http://www.licfe.org

MEMBERSHIP APPLICATION

Fields marked with a red asterisk ** are required

Applicants Name **

Designations and Certifications

Job Title

Are You Presently A CFE?	Yes No
If So, Enter Your Number
Are You A Member of the Association?	Yes No

Business Address

Company, Agency or School
Address**
City**	State Zip
Business Telephone**	Fax
Business E-Mail**
URL

Home Address

Address
City	State Zip
Home Telephone	Fax
Home E-Mail

Mail Preference: HomeOffice

Select your Membership Type

Chapter Member $50.00. A Chapter Member is required to be a Certified Fraud Examiner. Chapter Members are eligible to vote and hold office in the Chapter. Membership in the Association is required.
Chapter Associate $50.00. A Chapter Associate is not required to be a Certified Fraud Examiner. Associates are eligible to vote and hold office in the Chapter. Membership in the Association is required. Chapter Affiliate $50.00. A Chapter Affiliate is not required to be a Certified Fraud Examiner. Affiliate Members do not vote and cannot hold a position on the LICFE Board of Directors. Membership in the Association is not required.
Student Member $30.00. A Student Member is required to be a Full Time Student (12+ Hours) at an institution of higher education. Proof of full-time student status is required. Student Members do not vote and cannot hold a position on the LICFE Board of Directors.

I certify that the above is true and correct to the best of my knowledge. I have never been convicted of a felony offense. Falsification of any information on this application is grounds for denial or revocation of Membership. If this application is accepted, I agree to abide by the Bylaws and Code of Professional Ethics of the Association of Certified Fraud Examiners, and the Long Island Chapter of the Association. Membership is a privilege and not a right.

Membership is subject to the approval of the Board of Directors at their sole discretion. By submitting this application, the applicant hereby applies for membership in the Long Island Chapter of the Association of Certified Fraud Examiners and knowing that this association relies on the veracity of the applicant's statements herein as a condition and retention of membership, furnishes the above information:

Check the box at left to indicate that you agree with the above statements

(You must check the box above in order to submit your application.

Dues Are For The Calendar Year. Annual Dues Are Due December 15th, For The Next Year.

Please Make Your Checks Payable to The "LONG ISLAND CHAPTER-CFE", then

print this page and mail your completed application, check and a business card to:

LICFE, PO Box 1173, Bethpage, NY 11714

QUESTIONS? E-MAIL: LICFE MEMBERSHIP VICE PRESIDENT (click here)

© 2012 Long Island Chapter of the Association of Certified Fraud Examiners

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