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.