Regular Sponsorships

Your Name (required)*
First Last
Single Event or Multiple Events*
- Single Event
- Multiple Events
Employer*
Work Address*
Street Address Address Line 2 City State ZIP Code
Your Email (required)*
Work Phone*
Cell Phone*
Job Title*
Supervisor's Name*
E-Signature*
Sponsorship Type*
Select Events*
How Many Events*
Please enter a number greater than or equal to 2.
List the events for which you want multiple sponsors:*
Today's Date*
MM slash DD slash YYYY
*
I have read the above criteria for NYSSIU membership and warrant that I qualify for regular or associate membership.
*
My full time assignment is to an SIU within an insurance company of a self-insured corporation.
*
I understand this application is subject to acceptance by the Board of Directors 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 hereby make application for membership in the New York State Chapter of Special Investigation Units, Inc., in accordance with its Constitution and By-Laws and agree to be bound thereby.
Credit Card*