Rocky Mountain Chapter of RIMS
2016 Individual Chapter Associate Application
Company Name:
Type of Business:
Address:
________________________________________________________________________
_______________________________________ Fax Number
________________
______________________________________________________________________________
───────────────────────────────────────────────────────────────────────
Do you employ a Risk Manager, either full time or part-time?
Yes
No
PERSON DESIGNATED AS ROCKY MOUNTAIN CHAPTER ASSOCIATE MEMBER
Name:
Title:
________________________________________________________________________________
_________________________________________________________________________________
Telephone Number:
Email:
_________________________ Cell Phone:
___________________________
________________________________________________________________________________
Responsibilities:
_______________________________________________________________________
Check the committee(s) you are interested in serving on:
Membership
Legal/Legislative
Professional Development
Fundraising/Golf
Community Service
Financing/Audit
Communication
Programming
──────────────────────────────────────────────────────────────
Annual Dues - $180.00 per member


If you would like to pay by check, please send a check to Rocky Mountain RIMS, along with this
application, to: Treasurer, Rocky Mountain RIMS, 191 University Blvd. #825, Denver, CO 80206
If you would like to pay by credit card please go to: Individual Associate Membership Application.
Please note, there is a small credit card service fee for paying by credit card, so the total will be
$184.50.
This application must be accompanied with payment for the annual dues in full.
Please contact us at rockymtnrims@gmail.com for a prorated amount if you are joining mid-year.