ALLIED MEMBERSHIP Terms: $100 / Year Name of Applicant (First):* Name of Applicant (First) is Required Name of Applicant (Last):* Name of Applicant (Last) is Required Professional Initials of all Licenses or Certifications: Professional Initials of all Licenses or Certifications is not valid VaidyaDr.CMTCMPLAcMDNDDODCMissMr.Mrs.Ms.Other (Please state) Current Profession/s of Practice: Current Profession/s of Practice is not valid Do you hold a license or certificate? (Please name all): Do you hold a license or certificate? (Please name all) is not valid Applicant's email:* Applicant's email is Required Applicant's Phone number:* Applicant's Phone number is Required Applicant’s Mailing Address (Street):* Applicant’s Mailing Address (Street) is Required City:* City is Required State:* State is Required Country:* Country is Required Zip / Postal Code:* Zip / Postal Code is Required Business Name (if any): Business Name (if any) is not valid Business Website: Business Website is not valid Please describe the products or services that your business provides.: Please describe the products or services that your business provides. is not valid Profession:* Profession is Required Please attach a passport size photo for your member ID Card: Please attach a passport size photo for your member ID Card is not valid What brought you to CAAM: What brought you to CAAM is not valid Where did you hear about us?: Where did you hear about us? is not valid I have reviewed CAAM’s current requirements for the membership category for which I am applying and certify that I meet all of these requirements;* I will provide CAAM such other information and materials as CAAM may request at any time and from time to time, for the purpose of determining if I comply with the requirements and other standards in effect for membership in CAAM;* I shall act in a manner in compliance with all CAAM policies and requirements, and all applicable federal, state and local laws, and shall be careful to avoid any act or conduct which might injure, directly or indirectly, in any manner, the reputation of CAAM or any other person or entity associated with CAAM;* Approval of this application is within CAAM’s sole and absolute discretion;* My membership in CAAM, if approved, shall be for a one-year period, unless terminated earlier pursuant to CAAM’s rules, regulations, or other standards then in effect;* Should my membership in CAAM lapse or terminate for any reason, I understand that if I wish to renew my membership, I will be required to submit a new application and comply with CAAM’s membership requirements and other standards then in effect;* I hereby authorize CAAM, in its sole discretion, to perform and/or request criminal history checks and other background investigations to verify any and all information provided in connection with this application, and understand that discovery of false information in or related to this application, or of relevant criminal history, may result in denial or termination of this application, and/or my membership in CAAM;* All statements, answers, and representations made in this application and/or in any supplementary materials are true, accurate, and complete.* Date:* Date is Required Signature (By entering my name below, I authorize the use of my digital signature to confirm the above terms on behalf of me) :* Signature (By entering my name below, I authorize the use of my digital signature to confirm the above terms on behalf of me) is Required Email:* Invalid Email Password:* Invalid Password Password Confirmation:* Password Confirmation Doesn't Match Password Strength Password must be "Medium" or stronger No val Please fix the errors above
