ASAA Application

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

MEMBERSHIP APPLICATION

You can download the application in PDF format Here

If you do not have Adobe Acrobat you can download it free Here

Please write plainly or print. This application becomes a permanent record if you are accepted as a member.

Equal Opportunity Policy
It is the policy of The American Society of Equine 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.

Name (last)________________________

(First)________________________

(Middle)_______

Social Security Number________________________

Home Address (Street)___________________________________

(City) __________________________________

(State)___________

(Zip Code) _____________________________

Home Phone () ________________________________

Mailing Address ________________________________________

(City) __________________________________

(State)___________

(Zip Code) _____________________________

Business Phone () _________________________________

Do you have a valid driver's license?

Yes

Number_______________________________

State ________________________

Date of Birth __________________________

Expiration Date (Year)__________________

Do you have any relatives associated with this society?

Yes

Fax Number:_____________________________________________

Email Address: __________________________________________

STATEMENT OF HEALTH
Do you have any physical condition which may limit your ability to perform an appraisal? Yes No
If yes, explain

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

PERSONAL
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?
If yes, please elaborate. (Enclose a separate statement if necessary.) Yes No

___________________________________________________________________________________________

___________________________________________________________________________________________

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.

List professional organizations, special interests, or hobbies.

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

EDUCATIONAL DATA

School Attended

Name

City

State

Circle Last
Grade Completed

Major

Degree

High School

9 10 11 12

Community College

1 2

College or University

1 2 3 4

5 6 7 8

Trade School/ Apprenticship School

1 2 3 4

EMPLOYMENT RECORD --- List employment for the last 10 years, beginning with last or present job.

Company Name

Specific Duties

Street Address

City & State

(Telephone)

Job Title

Supervison

Reason for Leaving

Dates Employed Mo/Yr____________To Mo/Yr ___________ Salary _______________ Starting ______________ End ______________

Company Name

Specific Duties

Street Address

City & State

(Telephone)

Job Title

Supervison

Reason for Leaving

Dates Employed Mo/Yr___________ To Mo/Yr ___________ Salary _______________ Starting ______________ End ______________

Company Name

Specific Duties

Street Address (Telephone)

City & State

(Telephone)

Job Title

Supervison

Reason for Leaving

Dates Employed Mo/Yr___________ To Mo/Yr ___________ Salary _______________ Starting ______________ End ______________

IF YOUR EQUINE EXPERIENCE IS NOT SHOWN IN YOUR EMPLOYMENT RECORD, PLEASE INCLUDE A BRIEF EXPLANATION OF YOUR EXPERIENCE WITH HORSES.
Please place on a separate piece of paper if necessary.

___________________________________________________________________________________________

PERSONAL REFERENCES (Give four references, not relatives, who can vouch for your ethics, credibility and competence. It is important to type or print clearly, and be sure to include complete addresses, including zip code and fax number if available.)

Name: ____________________________________

Street: ____________________________________

City/State/Zip ____________________________________

Phone No.: ____________________________________
Fax No: ____________________________________

Name: ____________________________________

Street: ____________________________________

City/State/Zip ____________________________________

Phone No.: ____________________________________
Fax No: ____________________________________

Name: ____________________________________

Street: ____________________________________

City/State/Zip ____________________________________

Phone No.: ____________________________________
Fax No: ____________________________________

Name: ____________________________________

Street: ____________________________________

City/State/Zip ____________________________________

Phone No.: ____________________________________
Fax No: ____________________________________

PLEASE LIST PARTICULAR HORSE BREEDS AND DISCIPLINES YOU HAVE WORKED WITH OR ARE FAMILIAR WITH:

1. _____________________________________________
2. _____________________________________________

3. _____________________________________________
4. _____________________________________________

5. _____________________________________________
6. _____________________________________________

7. _____________________________________________
8. _____________________________________________

Are you willing to travel? _____________If yes, how far? _____________________

How many hours per week could you work?_________________

Do you have any other business interests that could compliment membership in this society? If so, explain:

___________________________________________________________________________________________

PLEASE READ BEFORE SIGNING. If you have any questions regarding the following statement, please ask them of a society representative before signing.

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 Equine 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 ASEA.

Signature _____________________________________________ Date___________________________________

MEMBERSHIP FEE SCHEDULE

Amount

$145.00

Processing Fee

Must accompany completed membership application.

$250.00

Remaining Certification
Fee

Must be mailed when notified of acceptance into the Association, along with signed Code of Ethics.

$395.00

Total Fee

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 [6] months after certification). If you have any questions regarding the above membership fees, please call the Association office.

Membership fees for the American Society of Equine Appraisers are deductible as ordinary and necessary business expenses.
SEC 6113 IRS. CODE

Please return this portion with your payment.

My check or money order enclosed

Please charge $ _____________________ to my

Card #___________________________________

Exp. Date ___________________________________

Signature___________________________________

Daytime Phone___________________________________

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