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<br />E. Interest...... Please check off any areas of interest/expertise thai: apply; <br /> <br />[J Career ResoUTCef <br />o Cmmnunity Relations <br />o CouncU~Manager Form of Government <br />o Councll~Manager Relations <br />o Emergency Management <br />D Envirorunental Management <br />D Ethics <br />o Finance <br />o Housing <br /> <br />F. U.s. Dues/P..}',nent <br /> <br />o Human Resoun:eslPeDonnel <br />o Human SeJViceslYouth at RIsk! <br />Health and Welfare <br />D EgovlInfo. Mgrnt.rrechnology <br />o local Government <br />ManagementIPerfonnance Measurement <br />o Management Innovations <br />o Planning and Economic Development <br />o PoDce and Fire ServiceslPublic Safety <br />o PubUcIPrlvate Partnerships <br /> <br />o Public Works <br />o Pure,,","'" <br />o Records ManagementiImaglng <br />o ReginnaUsm <br />o Service DelJvery <br />o Telecommunications <br />o Tnlining/Professionai Development <br />o TransJXlrtation <br />o Utilities <br /> <br />This application must be accompanied by dues payment in U.S. currency. ICMA dues are not deductible as a charitable contribution for <br />fedeT8l income tax purposes. but may be deductible as a business expense. <br /> <br />$215 of the annual membership <br />dues are for an annual subscription <br />to the leMA Ne_ $36 Is <br />for a yearly subscription to <br />Public ~tmagazlne. <br /> <br />Formu'" for Dues c........tion <br />I. Annual salary (includlng deferred compensation) ..............................$ <br />2. Annual dues (Line 1 x .0080) ..........................................................$ <br />3. Voluntary contribution to leMA Fund' ..........................................$ <br /> <br />TOUlI papnenl ..................................................................................$ <br /> <br />*Remember to make a contribution to the ICMA Fund for Professional Management. The fund was created for the support and <br />advocacy of the council-manager form of goverrunent and professional local goverrunent management. Your contribution is vital. <br /> <br />....,.....,t Inf........tion (check one) <br />D Enclosed is my check/money order. payable to ICMA in U.S. currency. <br />o Please chatge my 0 VISA 0 MasterCard 0 American Express <br /> <br />Account' <br /> <br />flip. Date <br /> <br />T""" <br /> <br />~gn"" <br /> <br />Date <br /> <br />Go ~.... to _ of Ethin <br /> <br />Print name exad:lyasit lIppeaf'5 011 card <br /> <br />I have read the enclosed ICMA Code of Ethics and agree to abide by it. I meet the appropriate membership criteria. <br /> <br />- <br /> <br />Date <br /> <br />Applications for Full or Associate membership status are announced in the leMA NewsJetteras required by ICMA's COl'L'ititutlon. Current <br />voting members have 60 days to file a written objection to an application for voting membenohip. Should an objection be raised, the can. <br />didate for membership will be notlfied and informed of the appeals process. If no objections are filed. the individual will be considered a <br />Member at the end of lbe 50-day period. <br /> <br />MIIil thll form with payment to: <br />ICMA Member Servlre;. 777 North Capitol SL NE. Suite 500. Wa.hingron. DC 20002-420L <br />You wUl start receiving member mailings within three weeks after leMA receives your completed application with payment. <br /> <br />On" retum ..... 1-4 to leMA. <br /> <br />page 4 <br />