Inland Empire Emerald Society www.IEES.ie

Application for I.E.E.S Membership
*Name:
*Address:
*City:
*State:		*Zip:
*Home Phone:
Cell Phone:
Work Phone:
Pager:
*Email (Work):
Email (Home):
*Agency:
*Division:
*Rank:
*Emergency Contact:
*Emergency Phone:
*Type of Membership: Please check only one.		Regular Associate Click the question mark for details
Society Member Sponsoring New Associate:
Type of Payment		Check Paypal/Credit Card
I, the undersigned, do hereby understand that being a member of the Inland Empire Emerald Society is a privilege and not a “right.” Further , I attest to be qualified for the requested membership status. Lastly, I proclaim to be of good character and a law-abiding citizen, willing and able to uphold and defend the Constitution of the United States of America, so help me God.

* Required Fields

After you submit the form, you will be redirected to the payment page.
If you prefer to pay by check, please mail it to the address below
and disregard the payment page.

Inland Empire Emerald Society
1040 S. Mount Vernon Ave., Ste G-333
Colton, California 92324-4221