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

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.


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 your Equine Experience is not shown in your employment record please include a brief explanation of your experience with horses ---Leave Blank If None---



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



13. PLEASE LIST THE HORSE BREEDS THAT YOU HAVE ACTUAL EXPERIENCE WITH, NOT JUST A KNOWLEDGE OF; ALSO, LIST THE DISCIPLINES (Western Pleasure, Barrel Racing, Eventing, Dressage, etc.) THAT YOU HAVE ACTUALLY PARTICIPATED IN:

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:

American Society of Equine 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.
Membership fees for the American Society of Equine 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 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.


By clicking "Submit" you affirm that all statements made within this application are true and that you agree to abide by all codes, regulations and reguirements, of The ASEA.

I agree: