MEMBER IDENTIFICATION  (Please print clearly)
Last Name _______________________ First Name _________________ Spouse _____________
Company Name/Affiliation ____________________________________________________
Address ___________________________________ City ________________ State ____ Zip ________
TELEPHONE AND WEBSITE INFORMATION
Telephone:   Home ________________________      Office: _____________________
Fax: ______________________ Pager/Cell: ___________________________
E-Mail Address: ______________________________________________
Website Address: ______________________________________________
Chapter Correspondence: Email ______ (preferred)      US Mail _______
MEMBERSHIP INFORMATION
ASHI No. ____________ (Required), if you have applied for an ASHI Number, write Pending
(You must apply for membership in ASHI National to qualify for membership in NOVA ASHI Chapter)
Applying for Membership Type, (only check one category)
____ ASHI Certified Inspector (With NOVA ASHI as primary chapter)
____ ASHI Associate w/Logo (Logo use privilege status in ASHI)
____ ASHI Associate (Has not achieved Logo-use or achieved ASHI Certified Inspector status)
____ Affiliate (ASHI Member having primary affiliation with another chapter)
____ ASHI Retired Status (Inspectors who have applied for Retired status with ASHI National)
____ Allied Professional (Member of a housing, real estate, home or construction related field)
PROFESSIONAL EXPERIENCE (Years)
Home Inspection: ____ *Construction Trades: *Carpentry ___ *Electrical ___ *Environmental ___
*GC/AIA/Engr ___ *HVAC ___ *Masonry ___ *Roofing ___ *Plumbing ___
COMMITTEE/SERVICE PARTICIPATION (We need volunteers)
__ Membership __ Education __ PR/Marketing __ Bylaws __ Legislative __ Special Projects
MEMBERSHIP DUES AND FEES
$110.00 **New Member: (First year for a new chapter applicant and name badge)            $ ___________
**Per ASHI National guidelines a $30.00 discount can be applied for a First time New Chapter Member Inspector only.
A signed Official coupon must accompany this application which is available from the chapter.- $30.00 $ ___________
$95.00  Renewal Fee: (Renewing Chapter Member and Affiliate)                                      $ ___________
$110.00  Allied Professional (Businesses or trades who do not perform home inspections) $ ___________
$35.00  Web Page Link: (A great way to advertise with pictures and biography)                  $ ___________
$25.00  Late Fee: (renewal must be postmarked by October 1st or a late fee is applied)      $ ___________
$75.00 Retired Member (Inspectors approved for Retired status with ASHI National)           $ ___________
     Legislative Fund (Voluntary contribution, Consult your accountant for tax deduction info) $ ___________
$7.00  New Name Badge (In the event you lost your original issue)                                       $ ___________
                           Date Paid: ________     Check Number: _______   Total Amount Paid: $ _________
Please make check payable to NOVA ASHI and submit to the chapter Treasurer
or mail to: Scott Del Monte, c/o NOVA ASHI, 13776 Ulysses St.,Woodbridge, VA 22191