AMERICAN SOCIETY OF EQUINE APPRAISERS
1126 Eastland Dr. N., Suite 100
P.O. Box 186
Twin Falls, ID 83303-0186
Phone: 1-800-704-7020
E-Mail: equine@equineappraiser.com
Fax: 208-733-2326 |
|
MEMBERSHIP APPLICATION |
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 is
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. |
|
|
|
|
Do you have a valid driver's license?
Yes
No
Number_______________________________
State ________________________
Date of Birth __________________________
Expiration Date (Year)__________________
Do you have any relatives associated with this society? Yes No
If yes, explain
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
|
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 |
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/
Apprenticeship
School |
____________ |
_________ |
____ |
1 2 3 4 |
_____________ |
_____________ |
|
|
EMPLOYMENT RECORD --- List employment for the last 10 years, beginning with last
or present job. |
Company Name: |
_________________________________________________________ |
Street Address: |
_________________________________________________________ |
City & State & Zip: |
_________________________________________________________ |
Telephone: |
_________________________________________________________ |
Job Title: |
_________________________________________________________ |
Supervision: |
_________________________________________________________ |
Dates Employed: |
Mo/Yr___________________ To Mo/Yr__________________ |
Reason For Leaving: |
_________________________________________________________ |
|
|
Company Name: |
_________________________________________________________ |
Street Address: |
_________________________________________________________ |
City & State & Zip: |
_________________________________________________________ |
Telephone: |
_________________________________________________________ |
Job Title: |
_________________________________________________________ |
Supervision: |
_________________________________________________________ |
Dates Employed: |
Mo/Yr___________________ To Mo/Yr__________________ |
Reason For Leaving: |
_________________________________________________________ |
|
|
Company Name: |
_________________________________________________________ |
Street Address: |
_________________________________________________________ |
City & State & Zip: |
_________________________________________________________ |
Telephone: |
_________________________________________________________ |
Job Title: |
_________________________________________________________ |
Supervision: |
_________________________________________________________ |
Dates Employed: |
Mo/Yr___________________ To Mo/Yr__________________ |
Reason For Leaving: |
_________________________________________________________ |
|
|
|
SELF EMPLOYMENT: If Self-employed or if your farm experience includes
self-employment, it is
very important to include a brief explaination for the past 10 years.
|
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 Address: ___________________________________________ |
City & State & Zip: __________________________________ |
Telephone: ________________________ |
Fax: ________________________ |
|
|
Name: ___________________________________________ |
Street Address: ___________________________________________ |
City & State & Zip: __________________________________ |
Telephone: ________________________ |
Fax: ________________________ |
|
|
Name: ___________________________________________ |
Street Address: ___________________________________________ |
City & State & Zip: __________________________________ |
Telephone: ________________________ |
Fax: ________________________ |
|
|
Name: ___________________________________________ |
Street Address: ___________________________________________ |
City & State & Zip: __________________________________ |
Telephone: ________________________ |
Fax: ________________________ |
|
|
|
|
PLEASE LIST THE HORSE BREEDS THAT YOU HAVE ACTUAL EXPERIENCE WITH (NOT JUST A KNOWLEDGE OF):
|
1. _____________________________________________ |
2. _____________________________________________ |
3. _____________________________________________ |
4. _____________________________________________ |
5. _____________________________________________ |
6. _____________________________________________ |
7. _____________________________________________ |
8. _____________________________________________ |
|
LIST THE DISCIPLINES (Western Pleasure, Barrel Racing, Eventing, Dressage, etc.) THAT YOU HAVE ACTUALLY PARTICIPATED IN:
|
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: (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.) |
|
American Society of Equine Appraisers |
$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 is enclosed.
Please charge $ _____________________ to my
Name On Card___________________________________
Card #___________________________________
Exp. Date ___________________________________
Daytime Phone ___________________________________
|
|
|
|
|
|