MEMBERSHIP APPLICATION

 

 

Please complete this application and forward it to the appropriate address provided at the bottom of this page. Your application for membership will be promptly processed.  A specific requirement to join the Association is graduation from a Certified or Basic Examiners Course sponsored by the IAVSA, NITV, VIPRE Systems, or FVSA.

Name:________________________________________________________________________

 

Dept/Organization:______________________________________________________________

 

Bus. Address:__________________________________________________________________

 

City:________________________St:______Zip:________Phone (____)___________________

 

E-Mail Address:_________________________________________Fax: (____)______________      

 

IAVSA/CVSA/VIPRE/FVSA Basic Certification:

Instructor:_____________________________________Graduation Date:____________________

 

VSA Recertification: (most recent)

 

Location of Training:_______________________________Graduation Date: _____________

  

CERTIFICATION

I certify that all information contained in this application is complete and true to the best of my knowledge.  I understand that any material omission, misrepresentation or falsification of this information is grounds for dismissal or refusal of membership to the IAVSA Association.  I hereby authorize investigation of all statements contained herein and give permission to contact any or all of my previous employers, references, and/or schools attended for information.

 

 

________________________________________________________   ___________________________

                                  Applicant’s Signature                                                       Date

 

Mail the application and a copy of your IAVSA, NITV, VIPRE, or FVSA certification certificate to the address listed below.  Membership with the International Association of Voice Stress Analysts, Inc. is free of charge to all examiners of approved voice stress instruments.