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.
 
 

Name (Last): __________________________________________

First: __________________________________________

Middle: ___________________________

Home Address: ____________________________________________

City: ________________________

State: __________________

Zip Code: _______________


Home Telephone ( ) ________________________

Cell Telephone ( ) ________________________

Business Telephone ( ) ________________________

Fax Number ( ) ________________________

Email Address: __________________________________________

Mailing Address: __________________________________________

City: ________________________

State: __________________

Zip Code: _______________


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 ___________________________________