Membership Interest Form

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First Name*
Last Name*
Business/Company*
Mailing Address
City*
State*
Zip*
Phone*
Cell Phone
Fax
Please add a brief biography*
Web Site
E-mail*
Membership Type	$125 Member $125 Affiliate
References*	Please list three professional references (paid or voluntary experience)
In addition to supporting the mission and values of the Alliance, we ask potential members to agree to the following principles of membership: To use an evaluation tool and process --either your own or one provided by the Assets Alliance-- with your clients to allow yourself to reflect on the quality of the services you have provided. To engage in the Alliance as a learning community by sharing your insights, experiences, tools, and resources developed as result of providing technical assistance. To contribute to the larger enrichment of the IDA and asset building fields.