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| Annual Membership Fee: |
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$15.00 (US Dollars) |
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| Payable to: |
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Insurance Internal Audit Group (IIAG) |
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| Tax Id: |
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22-2478126 |
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| Mail to: |
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Melissa H Hoover
305 N 3rd St.
Halifax, PA 17032
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PLEASE RETURN THIS NOTICE WITH YOUR DUES CHECK
NAME: ____________________________________________
TITLE: ____________________________________________
COMPANY: _________________________________________
STREET: ___________________________________________
CITY / STATE / ZIP CODE: ____________________________________________
TELEPHONE: _(_______)_________________ FAX: _(_______)________________
Please include Area code with telephone number and fax numbers.
EMAIL ADDRESS: _______________________________________________________
Note: Most communications by IIAG are now being conducted via the internet so an email
address is required for prompt receipt of materials. If you have any questions, please feel
free to visit our web site at : http://www.iiag.net
*CHECK HERE (__) if you have complete charge of internal auditing in your organization or group.
( ) Number in department including yourself.
( ) Please indicate if you would be interested in being a discussion leader or session chair.
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