Puget Sound Special Investigators (PSSI)

INTERNATIONAL ASSOCIATION OF SPECIAL INVESTIGATION UNITS - PUGET SOUND CHAPTER

Renew/Membership Application

REGULAR MEMBERSHIP (ANNUAL DUES - $25.00)

Pursuant to PSSI by-laws, “Regular” membership shall include insurance company employees and self-insured company employees primarily engaged in the investigation and/or supervision of insurance fraud investigation or Special Agent or supervisory Special Agent of the National Insurance Crime Bureau (NICB).  

You MUST be a member of IASIU to be a regular PSSI member.

 

ASSOCIATE MEMBERSHIP (ANNUAL DUES - $25.00)

Pursuant to PSSI by-laws, “Associate” membership shall include any representative of an insurance company, a local, state, or federal law enforcement officer, or prosecutor, a full-time investigator or investigations supervisor of a state insurance fraud bureau, or a representative of a government agency who is involved in or provides special expertise or services for the investigation of insurance fraud, who is endorsed in writing by a “regular” member and is not less than 21 years of age.

NAME: 

       Last

       First

Middle

BUSINESS ADDRESS: 

CITY:  STATE:  ZIP:   -

TELEPHONE: () -    FAX: () -

E-MAIL ADDRESS:

EMPLOYER:TITLE:  

POSITION DESCRIPTION:  (Please check one)

SIU INVESTIGATOR                       NICB                  LAW ENFORCEMENT    

OTHER     (Position)

SUPERVISOR: TELEPHONE: () -

 

I hereby make application for membership in the Puget Sound Special Investigators in accordance with its by-laws and agree to be bound therewith.  All of the information contained in this application is warranted by me to be true.  I understand this application is subject to acceptance by the PSSI Association and further that if my employment duties change so as to fall outside the requirements for membership, my membership in the organization shall terminate.  I further understand and agree that the Association may terminate my membership at any time, without refund of dues, by a majority vote of the Officers and Board of Directors and I hold the Association, Officers and Board of Directors harmless of any civil liability for any such termination.  PSSI will make all final decisions on Chapter membership.

 

MEMBER ENDORSEMENT: 

SIGNATURE:    DATE: //  Check if Renewal 

 

IASIU Member Number:    

You can now pay or renew your membership on line using or you may print your completed application (please click "SUBMIT" to print your confirmation) and forward along with your $25 membership fee to:

Puget Sound Special Investigators

P O Box 2201

Bothell, WA  98041

 

     Please add this code before submitting.