Association of Certified Fraud Examiners
Kentucky Chapter
Membership Application


I. Chapter Membership Dues for Fiscal Year 2006


Type of Membership

Membership Requirements
Chapter Member (CFE only): $30 annually A Member is required to be a Certified Fraud Examiner ("CFE")
  A Member is eligible to vote and hold office in the Chapter
  A Member is eligible to participate on Chapter Committees
  A Member is required to be a CFE, in good standing with the Association of Certified Fraud Examiners (the "Association"), Austin, Texas
   
Chapter Associate: $40 annually An Associate is not required to be a CFE
  An Associate is eligible to participate in Chapter Committees
  An Associate is required to be a member in good standing with the Association
Chapter Affiliate: $40 annually An Affiliate is not required to be a CFE
  An Affiliate is eligible to participate in Chapter Committees
  Membership in the Association is optional
   
Student Associate: $10 annually Same privileges as an Associate (see above)
Please submit proof of full-time enrollment
  List undergraduate program and school below:
Undergraduate program:_____________________________
  University or College:_______________________________


Membership Dues for new applicants are pro-rated fifty percent (50%) after February 1 of each fiscal year.
Renewal Memberships (Annual) are due before August 1 of each fiscal year.
Payment must accompany application/renewal.
Make checks payable to:

ACFE, Kentucky Chapter


Mail the completed application form, your check and a business card to:

Association of Certified Fraud Examiners
Kentucky Chapter #64
657 S. Hurstbourne Parkway #262
Louisville, KY 40222

Membership Dues to the Kentucky Chapter do not include dues for the Association of Certified Fraud Examiners, If you would like additional information about the Association please call (800) 245-3321 or
E-mail: acfe@cfenet.com


II. Personal Information



Mr./Mrs./Ms:  
First Name:  
Middle Name:  
Last Name:  
Home Address:
  
City:  
State/Province:  
Zip/Routing Code:  
Home Telephone:  
Home Fax:  
Home E-mail Address:  


III. Employment Information


Job Code (See next page):  
Industry Code (See next page):  
Employer:  
Job Title:  
Address:
  
City:  
State/Province:  
Zip/Routing Code:  
Business Telephone ( Extension ):  
Fax:  
Office E-mail address:  
Years employed:  


Preferred Mailing Address: ___ Home ___ Office





Please note that the above information you provide may be printed in the Chapter Directory








IV. Job Codes



01 Fraud Examiner Supervisor/Manager 61 Security Manager
10 Fraud Examiner 62 Security Investigator
11 Audit Manager 63 Security Consultant
12 Audit Supervisor 70 Law Enforcement Supervisor
13 Internal Auditor 71 Law Enforcement Investigator
20 EDP Audit Director 72 Private Investigator
21 EDP Auditor 73 Attorney
30 Accounting Professional 80 Educator-Ph.D., DBA, Ed.D., etc.
31 CPA, CA, etc. 81 Human Resources
40 Corporate Management 82 Retired
50 Management Consultant 90 Other
60 Director of Security  


V. Industry Codes


  AGRICULTURE, FORESTRY, FISHERIES   SERVICES
010 Agriculture, Forestry, Fisheries 600 EDP Services
    610 Educational Services
  FINANCIAL, INSURANCE, REAL ESTATE 620 Health Services
200 Banking and Financial Institutions 630 Hotels/ Lodging Services
210 Thrift/Savings & Loan Organizations 640 Legal Services
220 Credit Unions 650 Management Consultants
230 Other Credit Agencies 660 Membership Organizations
240 Non-Banking Bank Services (e.g., Leasing) 670 Public Accounting/ Accounting/ Bookkeeping
250 Holding/Investment 680 Social/ Personal Services
260 Insurance Carriers, Agents, Services 690 Miscellaneous Services
       
 
LAW ENFORCEMENT		   TRANSPORTATION/ COMMUNICATIONS
& UTILITY SERVICES
400 International Government 700 Air Transportation
410 Federal/National Law Enforcement 710 Land Transportation
420 State/Provincial Enforcement 720 Water Transportation
430 Local Law Enforcement 730 Other Transportation
    740 Communication Services
  MANUFACTURING 750 Electric/ Gas/ Sanitary Services
500 Chemical Petroleum, Refining, & Related Svc. 760 Mining
510 Electrical Machinery, Electronic Equipment. & Supplies 770 Gas & Oil Extraction
520 Food & Related Products 780 Other Utility Services
530 Leather/ Stone/ Glass/ Rubber & Plastic Prod.    
540 Lumber/ Wood Products (Furniture & Fixtures)   WHOLESALE & RETAIL TRADE
550 Metal Industries/ Fabricated Metal Products 800 Wholesale Trade
560 Paper, Related Products (Printing/ Publishing) 810 Retail Trade
570 Scientific, Photographic, Medical 820 Eating & Drinking Establishments
580 Textile Mills Products/ Apparel 830 Amusement & Recreational Trade
590 Miscellaneous Manufacturing Industries    
      NONCLASSIFIABLE
    900 Nonclassifiable Services or Industries








  1. Acknowledgement



I certify that the above is true and correct to the best of my knowledge. I have never been convicted of a felony offense. I have never been expelled from either the Association of Certified Fraud Examiners ("Association") or any of its affiliated chapters. Falsification of any information on this application is grounds for denial or revocation of Membership. If this application is accepted, I agree to abide by and be subject to the provisions of the Association's Bylaws and Code of Professional Ethics and the Kentucky Chapter's Bylaws. Membership is a privilege and not a right.

Signature: _________________________________________________

Date: _____________________________________________________

Referred by: _______________________________________________

Membership:___ Application___ Renewal