AMERICAN SOCIETY OF AGRICULTURAL APPRAISERS
1126 Eastland Dr. N., Suite 100
P.O. BOX 186
TWIN FALLS,
IDAHO 83303
(208) 733-2323
Fax (208) 733-2326 ­ E-Mail: ag@amagappraisers.com

MEMBERSHIP APPLICATION
It is the policy of The American Society of Agricultural Appraisers to recruit qualified personnel without discrimination because of Race, Color, Religion, Age, Sex, National Origin, or handicapped condition and to give no preferential treatment to any applicant.


1. Personal Information:
Last Name:
First Name:
Middle Name:
Address:
City:
State:
Zip:
Home Telephone:
  Format:  555-555-5555
Cell Telephone:
  Format:  555-555-5555
Business Telephone:
  Format:  555-555-5555
Fax:
  Format:  555-555-5555
E mail:

2. Mailing Information:
Mailing Address:
Mailing City:
Mailing State:
Mailing Zip:

3. Driving Information:
Do you have a valid drivers license? YES NO
License Number:
License State:
Date of Birth:
  Format: mm/dd/yyyy
Exp. Date:
  Format: mm/dd/yyyy


4. Do you have any relatives associated with this society?
YES NO

If yes, please explain ---Leave Blank If None---

5. Do you have any physical condition which may limit your ability to perform an appraisal?
YES NO

If yes, please explain ---Leave Blank If None---.

6. Have you ever been expelled from or given an official reprimand by a professional organization or been convicted of a felony related to business practices or ethics?
YES NO

If yes, please explain ---Leave Blank If None---

7. If you have been convicted of a felony, the nature of the felony and the length of time since conviction will be important considerations. If you have been convicted of a felony, you will not be automatically disqualified, and you will be given the opportunity to explain any convictions that adversely affect membership.

8. List professional organizations, special interests, or hobbies ---Leave Blank If None---




9. Employment Record: Please list employment for the last 10 yrs, beginning with the last or present job:

Company Name:
Street Address:
City:
State:
Zip:
Job Title:
Supervisor:
Specific Duties:
Telephone Number:
  Format:  555-555-5555
Start Date:
  Format: mm/yyyy
End Date:
  Format: mm/yyyy
Reason For Leaving:

Company Name:
Street Address:
City:
State:
Zip:
Job Title:
Supervisor:
Specific Duties:
Telephone Number:
  Format:  555-555-5555
Start Date:
  Format: mm/yyyy
End Date:
  Format: mm/yyyy
Reason For Leaving:



Company Name:
Street Address:
City:
State:
Zip:
Job Title:
Supervisor:
Specific Duties:
Telephone Number:
  Format:  555-555-5555
Start Date:
  Format: mm/yyyy
End Date:
  Format: mm/yyyy
Reason For Leaving:



Company Name:
Street Address:
City:
State:
Zip:
Job Title:
Supervisor:
Specific Duties:
Telephone Number:
  Format:  555-555-5555
Start Date:
  Format: mm/yyyy
End Date:
  Format: mm/yyyy
Reason For Leaving:



10. If self-employed or if your farm experience includes self-employment, it is very important to include a brief explanation for the past 10 years ---Leave Blank If None---



11. Schools Attended:
High School:
Name:
City:
State:
Last Grade Completed:
Community College:
Name:
City:
State:
Last Grade Completed:
Major:
Degree:


College or University:
Name:
City:
State:
Last Grade Completed:
Major:
Degree:


Trade School or Apprenticeship:
Name:
City:
State:
Last Grade Completed:
Major:
Degree:



12. Personal References: Give four references, not relatives, who can vouch for your ethics, credibility and competence. It is important be sure to include complete addresses, including zip code and fax number if available.)


Reference One:
Name:
Address:
City:
State:
Zip:
Telephone Number:
  Format:  555-555-5555
Fax Number:
  Format:  555-555-5555


Reference Two:
Name:
Address:
City:
State:
Zip:
Telephone Number:
  Format:  555-555-5555
Fax Number:
  Format:  555-555-5555


Reference Three:
Name:
Address:
City:
State:
Zip:
Telephone Number:
  Format:  555-555-5555
Fax Number:
  Format:  555-555-5555


Reference Four:
Name:
Address:
City:
State:
Zip:
Telephone Number:
  Format:  555-555-5555
Fax Number:
  Format:  555-555-5555



IF YOU ARE APPLYING FOR BOTH LIVESTOCK AND FARM EQUIPMENT DESIGNATIONS, PLEASE FILL IN BOTH LIVESTOCK AND FARM EQUIPMENT SECTIONS THAT YOU HAVE ACTUAL EXPERIENCE WITH, NOT JUST KNOWLEDGE OF.

13a. Livestock Applicants: (International Society of Livestock Appraisers) - Please list the particular breeds of livestock you are familiar with:

If None...Skip Step
1.
2.
3.
4.
5.
6.
7.
8.


13b. Farm Equipment Applicants: (American Society of Farm Equipment Appraisers) - Please list the brand names of farm equipment that you have worked with or are familiar with, including any specialized equipment:

If None...Skip Step

1.
2.
3.
4.
5.
6.
7.
8.


14. Are you willing to travel:
YES NO


If yes, how far:
miles


15. How many hours per week could you work:
hours


16. Do you have any other business interests that could compliment membership in this society? If so, please explain ---Leave Blank If None---


17. Membership Fee Schedule:

For Both Farm Equipment and Livestock there is a dual membership fee.

$180.00 Processing Fee
$315.00 Certification Fee
$495.00 Total Fee


If you are just applying for the American Society of Farm Equipment Appraisers:

$145.00 Processing Fee
$250.00 Certification Fee
$395.00 Total Fee


If you are just applying for the International Society of Livestock Appraisers:

$145.00 Processing Fee
$250.00 Certification Fee
$395.00 Total Fee



***   The only fee that will be applied to your credit card when submitting this application is the processing fee.   ***
***   If you are not accepted as a member, your processing fee will be refunded in full.   ***


Note:
In all cases, if your application for membership is denied, your processing fee will be completely refunded. Semi-annual dues are $55.00 per member (becomes due six months after certification). If you have any questions regarding the above membership fees, please call the Association office, 1.800.488.7570.
Membership fees for the American Society of Agricultural Appraisers are deductible as ordinary and necessary business expenses. SEC 6113 IRS. CODE


18. Credit Card Information:

Card Type:

Master Card Visa  American Express Discover

Amount Authorized:


  

Name On Card:


  

Card Number:


  Format: 5555-5555-5555-5555

3 Digit Number:


  Example:  123

Exp. Date:


  Format:  mm/yy


This is a secure transaction. Your credit information will be encrypted when sent.


Please Read Before Submitting:

If you have any questions regarding the following statement, please ask them of a society representative before submitting.

I authorize my previous employers, (please contact the Association Headquarters if you do not want to have your current employer contacted.) schools or persons named as references to give any information regarding my employment or educational record. I agree that my previous employers shall not be held liable in any respect if a membership is not tendered, is withdrawn or my membership is terminated because of falsity of statements, answers or omissions made by me in this questionnaire. In the event my membership with the American Society of Agricultural Appraisers is accepted, I will comply with all of the rules and regulations as set forth in this, or other communications distributed to all members.

I certify that all statements made by me on this application are true and complete to the best of my knowledge and that I have withheld nothing that would, if disclosed, affect this application unfavorably.

I hereby acknowledge that I have read the above statement, that I understand the same; and that I agree to abide by all codes, regulations and reguirements, of The ASAA.

I agree: