Application for IAFCS Membership Please fill out completely before submitting online. There is a $40 application fee. Name of Person Completing the Application: First: Last: Email Address: Reconfirm Email Address: Main Company Name (Please put TBD if you are still setting up your company name): If you have a different company name for your childproofing business (DBA), please list it now. This company will be included on the IAFCS website instead of your Main Company Name: What is the url for your company website?: http:// What is the main contact email for your company?: Name/Lead Contact: Title with Company for Lead Contact Person completing application: Please list other individuals associated with your business? The IAFCS requires all employees who educate the public to take the IAFCS Home Hazards Test (HHT). We will discuss the HHT during your membership interview: I am authorized to make decisions/act on behalf of my company: ---Select One--- YES NO Mailing address for business:   Phone number for your business: Please provide your complete home address (no P.O. Boxes): How long have you resided at your current home address?: years If you have resided at your current home address for less than one year, please provide your previous address. (Put NA if you have resided at your home for more than one year): Is there a different or additional person that is a Contact Person for your company?: Have you been trained by a childproofer?: --Select One-- YES NO If you completed a training program, please list the name of the company and dates of training. Enter NA if no training. If you were trained by a childproofer that has agreed to follow IAFCS Training Guidelines, your probation period for IAFCS referrals/website listing is 3 months. If no training, probation is 6 months. Training programs that have agreed to follow the IAFCS training guidelines are listed on the IAFCS Training Contact List after completing an application: Briefly describe any relevant professional experience  and/or qualifications. Include any certifications  or training not included above:  How long have you been in business?: --Select One-- We have not started yet Less than 6 months 6 months - 1 year 1- 2 years Over 2 years What type of services do you offer or plan to offer?: Childproofing Pool Fence Installations CPR Other, please specify: Please include any additional information about the services that you plan to offer. The IAFCS would like to know about all types of services that you plan to offer. Be specific as possible with product and service information: Please list all states or provinces where you plan to provide services. If you are located outside the U.S. or Canada, please just list your country. States will be listed on the IAFCS website in accordance with our IAFCS Website Listing Policy, http://www.iafcs.org/docs/Docs_Website_Listing_Info.pdf: Please write a short description of your business and/or services. You may email it to info@iafcs.org at a later date. Your description will be used on the IAFCS website with your business listing (after the website probation period): I/weI agree to follow the IAFCS Code of Ethics:   http://www.iafcs.org/docs/Docs_Code_Of_Ethics.pdf: --Select One-- YES NO Does your company carry general and professional liability insurance?  --Select One-- YES NO I am interested in participating in the IAFCS group insurance program We are still researching insurance options I understand that the IAFCS requires all members to pass the IAFCS Home Hazards Test before membership is activated. Once your application is approved, you will receive more information. There is a $35 per person testing fee. --Select One-- YES NO Have you ever been convicted of a crime? (Please contact us for privacy information) --Select One-- YES NO I prefer to discuss this with the Executive Director during the interview. Please explain how you learned about the IAFCS. The IAFCS sends updates to IAFCS members by email and in our newsletter (using Constant Contact). Do you agree to receive email updates and newsletters from the IAFCS? --Select One-- YES NO If you are applying for Associate Membership:  I agree that I do not offer or plan to offer childproofing services (including home evaluations) and if my services change, I will notify the IAFCS to update my membership type/requirements. In addition, I understand that Associate Membership is for individuals, not companies.  --Select One-- YES NO I am not applying for Associate Membership Thank you for submitting an application to be a member of the International Association for Child Safety (IAFCS). The IAFCS will contact you by email to schedule an interview. Please contact the IAFCS at info@IAFCS.org or 410-823-5120 if you have any questions.