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NATIONAL COUNCIL OF INVESTIGATION & SECURITY SERVICES, INC.%u201cOur Voice in Washington, DC and Across America%u201dMail to: P.O. Box 200615, Evans, CO. 80620-0615Email to %u2013 NCISS1976@yahoo.com Fax to %u2013 (970) 480-7794Annual Membership Dues RenewalPlease 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 %u2013 Regular / Gold Affiliate Associate Service $175 $175 $75 $250We now offer Auto Renewal %u2013 check here to authorize ___(Association memberships %u2013 please contact Executive Director Karen Beers directly)NCISS CREDIT CARD AUTHORIZATION FORM Member Name: Credit Card No.:Credit Card: VISA MC Amex CVV No. Expiration: Billing ZIP: 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