1. Member Information

* 1. Please provide the following information. Leave this section blank if you would prefer to complete the form anonymously.

* 2. Please indicate your membership and certification status.

  Yes No
Are you a member?
Are you a CIA?
(If not, would you be interested in a CIA prep class?)

* 3. FOR MEMBERS ONLY:

  Yes No
Would you be interested in helping with Chapter activities?

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