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NATIONAL COUNCIL OF INVESTIGATION & SECURITY SERVICES, INC.

“Our Voice in Washington, DC and Across America”

Mail to –P.O. Box 200615, Evans, CO. 80620-0615
Email to – NCISS1976@yahoo.com Fax to – (970) 480-7794

Annual Membership Dues Renewal

Please note: If you joined before June 2015, your dues expire December 31st.
If you joined after June 2015, your dues expire annually on your anniversary date.

Please verify that information is current on your NCISS profile.
Login at www.nciss.org/login to verify your status, and securely pay your dues online from your profile.

Please complete the following only if you have any changes and submit with your payment:

Member Name: ______________________________________ Agency: ___________________________________________

Mailing Address: __________________________________________________________

City, State and ZIP: ________________________________________________________

Email Address: ___________________________________________________________

Office Phone: _______________________ Cell Phone: __________________________

Amount Due – Regular / Gold Affiliate Associate Service
$175 $175 $75 $250
We now offer Auto Renewal – check here to authorize ___

(Association memberships – please contact Executive Director Karen Beers directly)

NCISS CREDIT CARD AUTHORIZATION FORM

Member Name:

Credit Card No.:

Credit Card: CVV No. Expiration: Billing ZIP:
VISA MC Amex

MEMBER DUES: __________ ( __ REGULAR __ AFFILIATE __ ASSOCIATE __ SERVICE)

LEGISLATIVE DONATION: __________

AMOUNT TO CHARGE: _______________

Please consider a Legislative Fund Contribution and a donation of $5 to offset credit card processing fees