P.O. Box 388085

Chicago, IL 60638-8085

Tel # 773-884-3638 & Fax # (773) 581-0192

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Application for Membership

To Register, complete the form below.

This form can also be printed printed and mailed to:

Illinois Security Chiefs Association
P.O. Box 388085
Chicago, Illinois 60638-8085

Please enter your name: (first, middle initial, last name)

Your title or position:

Your Present Employer:

Business Address:

City:    State:   Zip Code:

Business Telephone:    Fax Number:

Email Address

Synopsis of your responsibilities:


Name of immediate supervisor

Supervisors Title

Number of employees (total facility) Total Security Number you supervise

Applicant Resident Address:

City:    State:   Zip Code:

Home Telephone:    

Birth Date (MM/DD/YYYY)

Education History

High School

AA Degree

Bachelor DegreeYears

MastersYears

Applying For (check one:) 

I am applying for:   New Membership
                                   Renewal Membership

Membership Type:   
                                     General       $75.00
                                    
                                     

Standing Committees

Membership                   Banquet
Memorial Golf Outing Ad Book
Legislative                                            

Payment must accompany application. Please make check payable to: Illinois Security Chiefs Association.

I understand my application for membership in the association must receive a majority vote of the Board of Directors.  If for any reason this application is not accepted, all dues will be refunded.
      

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