NIRI Transfer Membership Form

While NIRI dues are not refundable, transfers of an individual membership can be made from one person to another within the same company.

Transfers can be made any time before the final 90 days of a membership term.

Please transfer NIRI membership from:

1. First name: *This question is required.

2. Last name: *This question is required.

3. Company Name: *This question is required.

4. By checking this box, the above individual is aware the membership is being transferred out of his or her name. *This question is required.

Please transfer NIRI membership to:

5. First name: *This question is required.

6. Last name: *This question is required.

7. Title: *This question is required.

8. Email address: *This question is required. This question requires a valid email address.

9. Address: *This question is required.

10. City: *This question is required.

11. State/Province/Territory: *This question is required.

12. Zip Code/Postal Code *This question is required.

13. Country:

14. Phone Number: *This question is required.

15. Year Started in IR:

16. Have you ever been cited for violating U.S. Securities and Exchange Commission regulations, or convicted of a felony? *This question is required.

17. By checking this box, I will abide by the NIRI Code of Ethics. *This question is required.

18. Comments: