NEW JERSEY LICENSEDPRIVATE INVESTIGATORS ASSOCIATION, INC.

P.O. Box 7199, Freehold, New Jersey, USA, 07728

Tel: (609) 423-7005 orEmail

MEMBERSHIP FORM

APPLICATION DATE: [ ] INITIAL APPLICATION [ ] RENEWAL

______

Member Name (Primary Member for Corporate)Expiration Date License Number State

______Payment made by Check #______or PayPal ____

Company/Trade Name (as it appears on license)

______May we list your information on the NJLPIA.org website?

Street Address

____ YES*____ NO * Please complete page 2.

______

City/State/Zip Code______

Website

______

County

______

Business Telephone Number

______

Fax Telephone Number

______

E-mail

______

E-Mail Address for listserv:

1. Write OPT OUT if you do not wantto be subscribed.

2. Or enter an alternate email address for listserv traffic.

Applicant is fully responsible for accuracy and content of directory listing information and can update data as needed.

MEMBERSHIP CLASSIFICATIONS

Membership is open to any licensed private investigator. Proof of license for out of state applicants is required. Regular members shall have the right to vote on all issues and receive a membership certificate and complete association benefits.

Membership entitles up to 3 officers/employees of a licensed investigative agency/ security company from any state. Proof of license for out of state applicants is required. Corporate members if Licensed, shall have the right to vote on all issues and each member shall have complete association benefits. Membership under this category terminates if an individual severs their relationship with the sponsoring investigative business.(LIST CORPORATE MEMBERS INFORMATON ON PAGE 2)

Membership is open to any investigator of a licensed investigative/security agency. Associate members shall not be entitled to vote.

SignatureTitleDate

Additional Investigators to Be Listed Under CORPORATE MEMBERSHIP:

  1. Name______Email______Lic#_____
  2. Name______Email ______Lic#_____

IMPORTANT!!

Once your information has been processed you will receive an email with instructions and your user’s name and password. You must go to the website and sign in. Once you sign in please CHANGE your PASSWORD.

You can then create your own business listing by following the appropriate link on the home page. You are responsible for maintaining your business listing with accurate information. If you change internet providers you must update the Administrator and Board of changes since notifications all go to your email address of record.

You will also receive an “INVITE” to join the NJLPIA yahoo group listserv, you must accept the invite in order to become a member of this group. Rules for the listserv are posted at the end of every message post, please make yourself familiar with these rules.

2014 NJLPIA, Inc. Rev. 09/02/2014