Inactive Member Application Form v.2

INSTITUTE FOR INTERNAL CONTROLS INACTIVE MEMBER APPLICATION
Description and Instructions:

Inactive Membership is restricted to those applicants who were certified by the IIC and currently are temporarily not involved in Internal Controls directly or indirectly, but who desire to remain updated on current events and eventually return to full CICA or CCS certification status. You may not use the CICA or CSS credentials or advertise as holding these credentials while on Inactive status.

Although you will have access to the IIC website, you will not have access to the Members Portal or any benefits limited to members in good standing.

***Note: that Inactive Members must renew their Inactive status annually by completing the form and paying the $50 reduced fee. Inactive status may only be maintained for 3 years, after which the member must apply for full membership and certifications or the member will be automatically terminated from membership in TheIIC.

For your convenience, Autofill will keep all your input data for 24 hours if you must leave the form before completing. You must use the same browser in order to pick up the form where you left off!
Annual Inactive Member Fee---$50.00

Please Complete all required information below

Personal Information:
Date of Application*

MonthDayYear
Member Number:
Salutation:*
First Name*
Middle Name
Last Name*
Local/Home Address*

Street Address

P.O. Box or Suite# (if Any)

CityState / Province

Postal/Zip Code (If you are applying from a country that does not utilize postal codes or zip codes, Type “N/A” or NONE. This field is not for PO Boxes)Country
Primary Phone*

Country CodeArea CodePhone Number
Alternative Phone

Country CodeArea CodePhone Number
E-mail*
Certifications Held:*

CICACCS
Inactive from:*

Corporate Internal Controls PositionPublic Employment in Internal ControlsAcademic Teaching in Internal ControlsOther
Date Effective:*

MonthDayYear

Applicant's Declaration

All applicants must declare their eligibility in the affirmative by checking the following statement to certify eligibility for Inactive Membership in the IIC and sign electronically in the signature space provided below:
Declare by checking both boxes below*

I am completely inactive from all positions involving Internal ControlsI understand that if I return to Internal Controls work I will immediately notify the IIC to change my status and reapply for the appropriate credentials.
NOTE: You MUST click the PRINT button on the “Submit and Pay” tab to provide a hardcopy of this form. You must do this before clicking the SUBMIT button since you may not be able to print out a copy of the form for your records once you click the SUBMIT button.
Type your name in the box below, followed by /es/ to represent your electronic signature
Method of Payment*

Credit CardCheck or Money Order sent by applicantCheck or Money Order sent by applicant's employerPayment Made directly to IIC country representatives (Pakistan, Greece, Philippines ONLY)
Applicant's Electronic Signature

Warning: Unsigned applications will be rejected!
Making a payment by credit card:

Select the credit card button above and follow all directions after you click submit. Note: Be advised that Affinipay is providing services as TheIIC's CC bank/vendor. If Affinipay does not operate in your country, contact membership@theiic.org immediately for a link to use an alternative CC vendor. No action on your application will be considered before receipt of payment in full.

Making a payment by mail:

If paying by Check or Money Order, Click on the Print Form Button below to print out a copy for you records, then click Submit button to send your completed application to the IIC. Send your Check or Money Order in the amount of $50.00 to:

Institute for Internal Controls

Attn: Membership Dept.

109 Mullen Drive

Sicklerville, NJ 08081

USA

Note - NO APPLICATION WILL BE ACCEPTED WITHOUT RECEIPT OF FULL PAYMENT AS REQUIRED.

NOTE: You MUST click the PRINT button on the “Submit and Pay” tab to provide a hardcopy of this form. You must do this before clicking the SUBMIT button since you may not be able to print out a copy of the form for your records once you click the SUBMIT button.

Should be Empty:

INSTITUTE FOR INTERNAL CONTROLS INACTIVE MEMBER APPLICATION

Personal Information:

Applicant's Declaration

Making a payment by credit card:

Making a payment by mail: