MEMBER/AFFILIATE/GUEST/APPLICATION
January 1, 2011 – December 31, 2011
(Please Type or Print Clearly)
Name: Mr./Miss/Ms./Mrs. _______________________________________________________
Job Title: _____________________________________________________________________
Business Name: _______________________________________________________________
Business Address: _____________________________________________________________
City: ______________________________ State: ___________________ Zip: _____________
Business Phone: ____________________ E-Mail Address: ____________________________
Home Address: ________________________________________________________________
City: ______________________________ State: ___________________ Zip: ______________
Send Mail To: Business Home
Certifications Held: CFE CPA Other:____________
Other Professional Memberships: _________________________________________________
Total Years Experience in Auditing, Investigations, and Consulting in Fraud: ______________
2011 Annual Dues
Certified Fraud Examiners $30 Full-Time Students $20
Non Certified ACFE Members $40 Affiliates/Guests of the Chapter $40
Career Search/Unemployed Status $10
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Or make check payable to CAC-ACFE and circle category & amount paid above.
Send application and payment to: Charlotte Area Chapter-ACFE
P.O. Box 35352
Charlotte, NC 28235
Attn: Treasurer; CC: Secretary
I hereby certify that the information contained on this application is true and correct. If accepted, I agree to abide by the CFE Code of Professional Ethics as well as the Chapter Bylaws as indicated on www.charlotteACFE.org.
Applicant’s Signature: _______________________________________ Date: ____________________