Personal First Name Middle Name Last Name SSN (last 4 only) Individual PI license # Date Of Birth Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Agency Agency Name PI Agency License # Business address Business City Business State - Select a value -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingDistrict of Columbia Business Zipcode Contact Information Mailing Street Address Mailing City Mailing State - Select a value -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Mailing Zipcode Work Phone Fax Number Cell Number Email Website URL Background & Professional Have you ever been convicted of a felony? - Select a value -NoYes If you have been convicted of a felony, please provide details Please list other professional associations to which you belong Order Please list other professional associations to which you belong (value 1) Weight for row 1 0 Membership Information Important Information: The New Member Fee is $125.00 / and the Annual Renewal Fee $75.00 (Renewal Fee is DUE by January 31st or new member fee applies) Memberships established in October, November, or December are valid for the remainder of that calendar year and the upcoming year. A Check or Money Order Only for $125 for new members and $75 for renewing members must be submitted with this application and (1) passport style photo (solid background). I authorize the OPIA, its officers, members, and/or agents to investigate the statements made on this application and to inquire into my reputation, character, qualifications and fitness for membership into the Association. I agree to abide by the OPIA Bylaws and Code of Ethics and to all amendments thereto. I agree to submit to binding arbitration in all disputes with OPIA members involving but not limited to work performance, fees, and professional conduct in accordance with all procedures. I consent to the inquiry described above and authorize the Council of Law Enforcement Education and Training to verify the license information that I have supplied herein. MembershipType - Select a value -Active (OK licensed PIAssociate (non-licensed/non-voting) Is this a new membership or renewal? - Select a value -New Membership ($125)Renewal of an Existing Membership ($75) My membership was solicited by (optional) Please add a passport style photo for use on your ID card One file only.8 MB limit.Allowed types: png gif jpg jpeg. Please Select Up 3 Specialty Codes Specialties Accident Reconstruction [ACC] Adoption/DNA [ADP] All Vehicles [AUT] Arson [AR] Asset Checks [AST] Aviation [AVN] Background Investigations [BNK] Bank & Account Fraud [BNK] Boating [BOA] Child Abuse [CHL] Child Custody [CUS] Civil Investigations [CVL] Computer Crimes & Fraud [COM] Construction Sites [CON] Corporate Investigations [COR] Criminal Investigations [CRM] Document Examination [DOC] Domestic [DOM] Drug [DRG] Drunk Driving Defense [DDR] Electronic Countermeasure Sweeps [ECS] Electronic Surveillance [ELC] Executive Personal Protection [EPP] Explosive & Firearms [EXP] General Investigations [INV] Industrial Accidents [IND] Insurance Adjusting [ADJ] Insurance Investigations [INS] Malpractice Medical & Legal [MAL] Maritime [MRT] Missing Persons [MIS] Nursing Home Investigations {NHI} Organized Crime [ORG] Patrol [PAT] Personal Injury [PIN] Personal Process Service [PPS] Photography [PHO] Polygraph [POL] Probate Mission Heirs [PRB] Product Liability [PRT] Real Estate [REA] Security Premises [SEC] Skip Trace [SJT] Subversive Terrorism [SUB] Surveillance [SUR] Toxic Asbestos [TOX] Trail Preparation [TRP] Video [VID] White Collar Crime [WHT] Workers Compensation [WKR] Please select up to four (4) codes describing your background, and list the number of years experience in each field. Order Please select up to four (4) codes describing your background, and list the number of years experience in each field. (value 1) Background Code - None -Federal Law Enforcement [FED]Government [GOV]Insurance [INS]Intelligence [INT]Investigative Journalism [JOU]Military [ML]On the Job Experience [OJE]Peace Officer [LEO or MUN]State Law Enforcement [STA] - None -1 Years2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years10+ Years Weight for row 1 -3-2-10123 Please select up to four (4) codes describing your background, and list the number of years experience in each field. (value 2) Background Code - None -Federal Law Enforcement [FED]Government [GOV]Insurance [INS]Intelligence [INT]Investigative Journalism [JOU]Military [ML]On the Job Experience [OJE]Peace Officer [LEO or MUN]State Law Enforcement [STA] - None -1 Years2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years10+ Years Weight for row 2 -3-2-10123 Please select up to four (4) codes describing your background, and list the number of years experience in each field. (value 3) Background Code - None -Federal Law Enforcement [FED]Government [GOV]Insurance [INS]Intelligence [INT]Investigative Journalism [JOU]Military [ML]On the Job Experience [OJE]Peace Officer [LEO or MUN]State Law Enforcement [STA] - None -1 Years2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years10+ Years Weight for row 3 -3-2-10123 Please select up to four (4) codes describing your background, and list the number of years experience in each field. (value 4) Background Code - None -Federal Law Enforcement [FED]Government [GOV]Insurance [INS]Intelligence [INT]Investigative Journalism [JOU]Military [ML]On the Job Experience [OJE]Peace Officer [LEO or MUN]State Law Enforcement [STA] - None -1 Years2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years10+ Years Weight for row 4 -3-2-10123 Publicly Listed Information One of the benefits of membership is your listing on the OPIA Worldwide Internet Website @ www.opia.website. The Specialty and Background information you submit will be included in your listing. Note: It is very important that you keep the Secretary informed of changes in the submitted information, which you may update by visiting the website or contacting the OPIA Secretary—please keep this information current. Failure to do so may affect your receiving referrals from the answering service. I would like my website to be listed in the OPIA online member directory Would you like your website address published on the OPIA website - Select a value -Publish my website address on the OPIA websiteDo not ublish my website address on the OPIA website Which address would you like published on the OPIA website? - Select a value -I do not want my address publishedPlease publish my mailing addressPlease publish my business address Which phone number would you like published on the OPIA website? - Select a value -I do not want my phone number publishedPlease publish my business phone numberPlease publish my cell phone numberPlease publish both my business and cell numbers By typing my name below and submitting this form, I declare under penalty of perjury that the statements made in this application are true and correct. I have read and understand this application and the current OPIA by-laws. I acknowledge the tenants and goals of the Oklahoma private investigators association and agree to abide by them. I also understand that failure to maintain my PI license in accordance with Oklahoma State Law will be grounds to forfeit my membership in OPIA! I understand that failure to maintain my PI license in accordance with Oklahoma State Law is grounds to forfeit my membership I have read the OPIA Code of Conduct I have read the OPIA by-laws Please select a payment option: - Select a value -Pay online using PayPalMail a Check If paying by PayPal, please go to Make a Payment, please send checks to P.O. Box 690091 Tulsa, OK 74169-2241. Please type your full name to agree to the above terms CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
