Long Island Chapter of Association of Certified Fraud Examiners (CFE)

255 Executive Drive - Suite 107•Plainview, NY 11803
Phone: 516.576.0555 ext. 501•Direct Fax: 516.944.3811

E-mail: info@licfe.org  Internet: http://www.licfe.org

MEMBERSHIP APPLICATION

Fields marked with a red asterisk ** are required

Applicants Name **

Designations and Certifications

Job Title

Are You Presently A CFE? Yes  No
If So, Enter Your Number
Are You A Member of the Association? Yes  No
Are You a NYC Chapter Member? Yes  No

Business Address

Company, Agency
or School
Address**
City** State** Zip** 
Business Telephone**   Fax
Business E-Mail**
URL

Home Address

Address
City State Zip
Home Telephone   Fax
Home E-Mail

Mail Preference: HomeOffice

Select your Membership Type

Chapter Member $30.00. Must Be A Certified Fraud Examiner
Chapter Associate $35.00. Not Required To Be A CFE
Student Member $10.00. Proof Of Full-Time (Resident) Student Status Required

Dues Are For The Calendar Year. Annual Dues Are Due December 15th, For The Next Year.

Payment Information 

Payment Method: Visa   Mastercard  Amex   Check
If paying by check, please Make Your Checks Payable to The "LONG ISLAND CHAPTER-CFE", then print this page and mail your completed application, check and a business card to LICFE, 230 Hilton Avenue, Suite 15, Hempstead, NY 11550
Credit Card No:
Exp Date (Please enter as MO/YR)
Cardholders Name
Zipcode of Credit Card Billing Address

I certify that the above is true and correct to the best of my knowledge. I have never been convicted of a felony offense. Falsification of any information on this application is grounds for denial or revocation of Membership. If this application is accepted, I agree to abide by the Bylaws and Code of Professional Ethics of the Association of Certified Fraud Examiners, and the Long Island Chapter of the Association. Membership is a privilege and not a right.

Membership is subject to the approval of the Board of Directors at their sole discretion. By submitting this application, the applicant hereby applies for membership in the Long Island Chapter of the Association of Certified Fraud Examiners and knowing that this association relies on the veracity of the applicant's statements herein as a condition and retention of membership, furnishes the above information:

Check the box at left to indicate that you agree with the above statements

 (You must check the box above in order to submit your application.

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