North Carolina Internal Affairs Investigators Association

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"Ensuring Professional Law Enforcement Standards "

Membership Application
(July 1, 2008 through June 30, 2009)



Please print out the form below and send your check and the printed form to the address listed below.
NCIAIA Online Membership Renewal Form or Brand New Member Form

Agency (New ___ Renewal ___)

Agency Name__________________________________________________

Agency Address ________________________________________________

Telephone Number_______________________________________________

Fax __________________________________________________________

Department Members to be included:

Name ___________________________________ Email Address
Name ___________________________________ Email Address
Name ___________________________________ Email Address
Name ___________________________________ Email Address

****Federal Tax ID number (if applicable): 56-1723847
Return application with check payable to NCIAIA ($25.00 per agency) to: NCIAIA

To:

NCIAIA

C/O Det. Sgt. Dee Dee Jones
1153 Still Meadow Drive

Creedmoor, NC  27522

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