SIR Membership Application
You must apply and be approved for membership. We do not limit the number of industries or disciplines. Dues are payable upon acceptance.
Applicant name (first and last name)
Business Address (street address, city, st, zip)
Telephone number nnn-nnn-nnnn
Type of business or industry
Number of years in business or profession
Certifications (if applicable)
How does your company help/serve the older population?
Have you ever been convicted of a felony or elder abuse?
I agree to the following (check each item)
I always focus on the best interests of my client or referral.
I understand nothing can be sold at SIR events.
I have read and agree to abide by the member expectations.
I hold harmless SIR, its members and venues from any injury incurred at any event.
I understand my membership can be revoked for dishonest dealing or any type of elder abuse.
$159 annual membership fees are due upon acceptance of membership.
I do not expect compensation from or to any member for a referral.
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