(Last name:________________________________________________,
(DOB) _____________
(First name)______________________________________
(MNI)_____________
(Home address ) ______________________________________________
(City)______________________(st)____
(zip)____________________
(Home ph #)(____)___________________
(Work ph#)(_____)__________________
(Fax #)(_____)____________________
(Employer's name and address)________________________________________________________________
________________________________________________________
(your e-mail address)________________________________________________
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Send my mail to: [ ] My
home address [ ] My business address
I am applying for: [ ] REGULAR
MEMBERSHIP STATUS [ ] ASSOCIATE MEMBERSHIP STATUS
Regular membership:
Shall be granted only after submission of membership application with all required
attachments and upon approval by the Board of Governors. One-time, Non-refundable
Processing Fee: $15.00 Annual Dues: $25.00
Associate membership:
Shall be granted to individuals who have a primary or secondary interest in
transportation accident reconstruction and who wish to support the goals and
objectives of this organization. Associate members have no voting rights. One-time
Processing Fee: $10.00 Annual Dues: $25.00
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REGULAR MEMBERSHIP QUALIFYING
INFORMATION
1. Have you completed a
prescribed curriculum of accident reconstruction? [ ] Yes [ ]No
2. If Yes, list the date
of attendance, name of school, city and state, and ATTACH a copy
of your certificate of successful completion of the course.
3. If NO: (a) how did you
gain your knowledge; and, (b) are any of TAARS' members familiar with your work?
(Use an additional page if necessary.)
4. Are you:
(a) ACTAR Accredited? [
] Yes [ ] No
(b) A Reconstructionist
Grade member of SOAR? [ ] Yes [ ] No
(c) A member of any other
accident reconstruction organization? [ ] Yes [ ] No
(d) If you answered YES
to any of the above, please ATTACH a copy of your certificate.
5. Have you testified in
criminal or civil procedures using accident reconstruction methodology? [ ]
Yes [ ] No
If YES, how many times
and what methods did you use? (Use an additional page if necessary.)
6. If the Membership Committee
requests:
(a) Would you be willing
to be tested, at a place near you, using accident reconstruction methodology?
[ ] Yes [ ] No
(b) Would you be willing
to submit at least two case files of your reconstruction work? [ ] Yes [ ] No
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TAARS attempts to furnish
each member with a current roster annually. TAARS does not, knowingly, distribute
its membership roster to any person or organization to be used for solicitation
of business or retail purposes. However, from time to time, businesses or companies
request a roster from which they may select a member to be retained as a consultant
or expert in a particular field of accident reconstruction. TAARS does not qualify,
certify or make recommendations for any member to fill any position. TAARS will
make available to these entities, upon request, a list of members who specifically
request to be included on such a roster.
*** [ ] Please include
my name on a list of members available for consultation.
*** [ ] DO NOT include
my name on a list of members available for consultation.
*** SIGNATURE REQUIRED:____________________________________________
DATE:________________
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PAYMENT BY: [ ] Check [
] Credit Card [ ] Cash (mailing of cash is discouraged)
Total Enclosed: Processing
Fee ($10 or $15)$________________ + ___ Years Dues @ $25/year = ____________________
Charge to my: [ ] American
Express [ ] MasterCard [ ] VISA
Card #: ____________________________________________________________
Exp Date: ___________________
Name as it appears on card,
please print:
__________________________________________________________
Authorizing Signature:
____________________________________________________________
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To expedite processing
of this application, mail it directly to:
Michael Yosko, TAARS' Secretary,
6580 Howe, Groves, TX 77619 Home: (409) 963-3146
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FOR MEMBERSHIP COMMITTEE
USE:
Date(s) of consideration:
______________________________________
Recommended for: [ ] Regular
Membership [ ] Associate Membership [ ]
Needs add'l documentation:
_____________________________________
Chairman's Signature:
______________________________________________________________
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