Membership Application

* First Name

* Last Name

* Email

Address

Address 2

City

Zip

Phone

Cell

* County of Residence

* Agency

* Rank

* Agency Address

* Agency State/City/Zip

* Agency Supervisor

* Agency County

* Agency Phone

* I would like to receive tips from IDEA
YesNo

I would like tips based on the following county selections:

You may select multiple counties by holding down the CTRL key on your keyboard while clicking the selection with your mouse.

*By submitting this form, you or your department will be billed $75 for membership dues. Please note that you do not need to be a member in order to attend our classes.