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Member Application
*
Username :
[
your email address is your user-name
]
*
Password :
*
First Name :
*
Last Name :
Gender :
Male
Female
Have you ever been convicted of a felony?
Yes
No
If Yes, Please Explain
Main Discipline: (check one)
Antiques & Residential Contents (ARC)
Fine Art (FA)
Gems & Jewelry (GJ)
Machinery & Equipment (ME)
Other (O)
If Yes, Please Mention
Secondary specialty:(check one)
Antiques & Residential Contents (ARC)
Fine Art (FA)
Gems & Jewelry (GJ)
Machinery & Equipment (ME)
Other (O)
If Yes, Please Mention
*
Business Name :
*
Street :
*
Town :
*
State :
*
Zip/Post code :
Country (if outside of USA) :
*
Main Phone # :
(
include country code if outside the USA
)
Mobile # :
Fax :
Location coverage of your business :
Membership affiliations and designations :
ISA
Designation
ASA
Designation
AAA
Designation
NAJA
Designation
IAA
Designation
Other(s) list
Designation
*
Rate per hour :
$
to $
Website [
start with http://
] :
Referral discount to hiring or referring appraiser :
Select Any
5%
10%
15%
20%
25%
30%
45%
50%
Availability notice for referred work :
[
# days/weeks
]
Willing to travel?
Select Any
US
Within State
World
USPAP Certified?
Yes
No
Date tested and where?
Certificate available?
Yes
No
Education :
Expert Witness Training?
Yes
No
Expert Witness Experience?
Yes
No
Years in appraisal industry and year started :
High School Diploma?
Yes
No
College?
Yes
No
1. College
Years Attended
Degree
2. College
Years Attended
Degree
3. College
Years Attended
Degree
References:
References1:
Contact Name/Title :
Business Name :
Street Address :
City :
State :
Zip :
Phone :
Fax :
Email :
References2:
Contact Name/Title :
Business Name :
Street Address :
City :
State :
Zip :
Phone :
Fax :
Email :
References3:
Contact Name/Title :
Business Name :
Street Address :
City :
State :
Zip :
Phone :
Fax :
Email :
Validation String :
[
Please enter the string shown in the image in the textbox above
]
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