I.A.A.R.S. Member Application

See the previous page for procedures and information on where to mail this application.

IAARS Membership Application
Name

Last

  

First

 

MI

  
Home

Street Address

  
City   State   ZIP  
Business Address (if applicable)

Business Name

 .

Street Address

 .

City

  

State

   ZIP  

Correspondence should be sent to (circle one)

 Home Business  

Previous employment for last 10 years (attach sheet if necessary)

 Employer Address From/To Job Title Reason for Leaving
. . . . .
. . . . .
. . . . .

Accident investigation/reconstruction courses attended (attach sheet if necessary)

 College/University/Other Address Course Date Attended
. . . .
. . . .
. . . .

Testified in court as a
reconstruction expert? (circle one)

 Yes No Number of times  

 

If so, please fill in this information

 Date Case Name (last two only) Select one Name of Court
. . Civil Criminal .
. . Civil Criminal .
By my signature I hereby make application to the International Association of Accident Reconstruction Specialists (IAARS) for the status indicated below.  I certify that the above information is true, correct & complete to the best of my knowledge.  In addition, I hereby authorize the IAARS, through its representatives, to verify any information provided by me.

Signed

.

Date

.

Status applying for (circle one)

 Member Member with Diplomate Status Member with Fellow Status

FOR OFFICE USE ONLY
Date received . Date sent to board .  
Fee received . Date of conference call .
Indentification Number . Approved Yes No