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PERSONAL INFORMATION
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| Salutation |
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First Name |
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| Middle Initial |
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Last Name |
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| Job Title |
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Social Security Number |
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My primary mailing address is my:
(NOTE: You must enter a complete address for whichever you
choose as your primary mailing address.) |
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WORK - CONTACT INFORMATION
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| Company |
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| Work Address 1 |
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| Work Address 2 |
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| Work City |
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Work State/Province |
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| Work Zip/Postal Code |
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HOME - CONTACT INFORMATION
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| Home Address 1 |
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| Home Address 2 |
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| Home City |
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Home State/Province |
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| Home Zip/Postal Code |
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COLLEGE/UNIVERSITY -
CONTACT INFORMATION
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| College/University
Name |
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| Address 1 |
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| Address 2 |
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| City |
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State/Province |
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| Zip/Postal Code |
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| Phone (in case you need to be contacted for exam location/time change information): |
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| Email : |
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| Country: |
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In order to qualify for Loss Prevention
Qualified/Certified written exam, individuals must answer "no" to the following
questions:
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| Have you ever been
convicted of a felony, or if in military service convicted
by a general court martial? |
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| Have you ever been
convicted of a misdemeanor involving moral turpitude ("moral
turpitude" means an offense that calls into question the
integrity or judgment of the offender, such as fraud, bribery,
corruption, theft, embezzlement, solicitation, etc.)? |
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| Are there any criminal
charges (felony or misdemeanor involving moral turpitude)
now pending against you? |
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I certify, to the best of my knowledge that the answers
to the questions above are true. I realize that falsification
of information on this membership application will result
in the forfeiture of membership, as well as the registration
fee I have paid. |
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In order to take the written exam, I recognize that I need to have at least a High School or GED education level. Checking this box certifies this. |
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| Please choose one
of the following options to continue: |
I HAVE A REGISTRATION TAG - Please enter your Registration
Tag below: |
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- OR -
I WANT TO PAY ONLINE (Please select your membership
option if you have not already):
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Loss Prevention Qualified (LPQ) Exam - $250.00 |
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| Please select: |
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NOTE:
You do not
need a PayPal account to enroll online - simply choose
the "Credit Card/Bank Account" option on the
next page, as shown below:
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