6. Undergraduate university, year and degree:

7. Law/Professional school and/or additional universities and graduate universities attended and degrees awarded:

8. Bar admissions, if any, including jurisdiction, date and whether in good standing :

9. Professional titles:

10. Number of years in practice in law, accountancy, other profession:

11. Career history. Please detail employer’s name or association, dates and addresses of professional offices for last ten years:

12. Offices held in legal, professional and/or franchisees organizations along with dates:

13. Other contributions to your profession and franchising. Please detail your   efforts made to teach, advise or otherwise advance franchising, including honors received:

14. Have you ever been disciplined, sanctioned, reprimanded, suspended, expelled or disbarred by any professional organization, authority, bar or court and/or any disciplinary proceedings or grievances pending against you with any disciplinary authority?
YES   NO
If so, please furnish dates and explanations:

15. What percentage of your practice or professional activities in each of the last five years has been in the area of franchising ?
Year      %
Year      %
Year      %
Year      %
Year      %

16. What percentage of your practice or professional activities in each of the last five years has been in the area of representing franchisees or franchisee associations?:
Year      %
Year      %
Year      %
Year      %
Year      %

17. During the past five years, approximately how many franchise clients have you represented or provided services to?

18. Explain what you have done during the past five years to broaden your knowledge and competence in the field of franchising and/or franchise law. Include a list of the educational courses you have attended or taught, by date, location, sponsoring authority and the number of hours per year so designated:

19. Have you read the Standards for AFA Affiliate Members?
Yes  No

20. Have you agreed to all provisions contained in the Standards for Admission for AFA Affiliate Members?
Yes  No

21. Have you read the Standards of Professional Practice for AFA Affiliate Members ?
Yes  No

22. Will you follow and promote the Standards of Professional Practice for AFA Affiliate Members?
Yes  No

Agreement to Carry Out and Abide by AFA Mission Statement and Standards for Practice
23. If I am granted membership, I agree to abide by and actively promote the AFA   Mission Statement, Standards of Professional Practice for AFA Affiliate Members and all other AFA policies as the same may be in effect from time to time.

24. If I am granted membership, I agree to abide by the highest ethical standards of my profession.

Agreement to Procure and Maintain Professional Liability Insurance
25. If I am granted membership, I agree to procure, at the latest upon my admission into the AFA, and maintain for the duration of my membership, a professional liability insurance policy in an amount not less than $1.0 million. I agree to supply a certificate of professional liability insurance policy as evidence of my compliance with this provision. I understand that the Affiliate Membership Committee may, in its discretion, modify this requirement and/or allow me to post a bond or otherwise demonstrate sufficient means and resources to discharge any obligations or claims arising from alleged professional errors and omissions. If professional liability insurance coverage is inapplicable or unavailable for my profession or position, or there are other circumstances I wish to be considered, it is my responsibility to raise these considerations during the application process.

Agreement to Indemnify AFA
26. If I am granted membership, I agree to fully and completely indemnify and hold harmless the AFA from any cost, claims, liabilities, damages, suits, actions and all legal costs, fees and expenses associated with any and all actions or threatened actions that are related to or arise out of my conduct or that of my agents, and for which the AFA is in anyway held or sought to be held responsible or liable, whether directly or vicariously, including, but not limited to the cost of defending any claim, counterclaim, cross-claim or any such threat of such.

Acknowledgment of Acceptance of Membership as Good Consideration
27. I acknowledge that I have read and understand the Standards of Admission for AFA Affiliate Members, in advance of applying for membership, which is incorporated by reference, and further, I state that if I am granted membership as an AFA Affiliate Member and I accept this membership, this constitutes good and valuable consideration for my agreements herein.

28. I authorize the AFA to investigate and make inquiries of any bar association or other professional association as to my credentials and my qualifications for membership in the AFA.

29. I hereby waive all rights of confidentiality relating to this application, and further agree that the AFA, in pursuance of the investigation of this application need not reveal to me its deliberations or the results of its inquiries concerning my application for membership, and in particular any possible negative material pertinent to this application. I agree that all material submitted by me shall become the property of the AFA which need not be returned to me and I understand that a copy of my AFA Affiliate Membership Application may be given to parties inquiring about me to the AFA. I further agree that a photocopy of this application may be used to authorize the release of information from any person, firm or authority from which the AFA may seek to obtain information concerning my application.

30. I acknowledge that by applying for Affiliate Membership in the AFA, I will be causing the AFA to seek frank and candid reviews of my professional competence and ethical standards. I agree that it would damage the integrity of the application and review process if I ever attempted to seek access to such information or to the deliberations of the AFA. For these reasons, and in consideration for the AFA’s review of my application, I expressly and voluntarily waive and relinquish any right that I have, whether through litigation or in any other manner, to challenge the procedures, investigation and deliberations, references or decisions of the AFA, relating to my consideration for membership.

Applicant _____________________________________   Date__________________  

Instructions
Please enclose
a. your $1,550.00 Affiliate Membership fee ($150.00 of which is a non-refundable processing fee);
b. a copy of your current malpractice and/or errors and omissions insurance policy; and
c. a one page resume which the AFA will use as part of its referral process.

Once you are granted Membership you will receive a letter of notification. If you are not granted Membership, you will also receive a letter of notification and will be refunded $1,500.00.

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