IIA membership number _ THE INSTITUTE OF INTERNAL AUDITORS, INC International Headquarters, 249 Maitland Avenue Altamonte Springs, Florida 32701, Phone: 305/830-7600 MEMBERSHIP APPLICATION Application may be submitted to IIA International Headquarters or to local chapter for processing Please Type or Print Clearly (if more space is necessary, attach separate statement) PERSONAL DATA.Mr. .Mrs. .Ms. .Other _Name. _ (Last) (First) (Middle)Home Address _ _City_State/Province _ Zip/Pin Code _Country _Home Phone (Include country & city code) _E-mail Address, if available _Mail to be sent to your ( ) Home Address ( ) Business Address Name exactly as you want it to appear on membership certificate EDUCATIONGraduation Degree _ Year _Highest Degree _ Year _Professional Qualification, if any (Mention name of the Institute also)_ BUSINESS DATACompany _Address_City_ State/Province _Zip/Pin Code _ Country _Business Phone (Mention country & city code) _Type of Business _Company Size by number of employees /Locations _Designation/Job Title_Nature of Responsibilities _Period Employed _ Years in present position _Are the auditing activities of your company under your jurisdiction? Yes ( ) Partly ( ) No ( )Do you direct & supervise audits Yes ( ) Partly ( ) No ( )Number of Internal auditors on company staff _Specify fully the nature of your auditing duty _ REFERENCESTwo reference names are required. It is preferable that one of them be a member of The Institute of Internal Auditors,Inc. The second reference should be a business acquaintance. If you do not know a member of The Institute, give two business references. References not required for CIAs.1. Name _ Position _ Business Affiliation _ Address _ _City _ State/Province _ Zip/Pin Code _ Country_Telephone Office _ Residence _Member of IIA: Yes ( ) No ( )2. Name _ Position _ Business Af