NAUIAB REGISTRATION FORM

NAUIAB Membership Application
NAUIAB Members please logon and use the 'Members' Registration Renewal Form' located on the Members' Menu Page...

If you have been a prior member of NAUIAB and
know your logon userid, enter it here:

First/Last Name:

Title:

Agency:

Mailing Address:

City St Zip: , .

Phone:

Fax:

Email:

FEES:

Membership Dues: $50.00
Membership Category:
Pursuant to NAUIAB By-laws:
A person is eligible for Active (voting) Membership if he or she regularly performs at least one of the following functions:

decides unemployment insurance higher or lower authority cases;
as a state employee, assists in the issuance of decisions or the defense of higher authority;
directly supervises lower authority hearing officers.

A person is eligible for Associate (non-voting) Membership if he or she meets one or more of the following criteria:

is a former member of the Association who is no longer eligible for active membership;
is a governmental employee and is involve in legal affairs related to the unemployment insurance appeals process;
is involved in the administration of unemployment insurance appeals;
is a non-governmental party involved in the administration of unemployment insurance appeals and/or represents claimants or employers at unemployment insurance appeals hearings and/or advises claimants or employers in unemployment insurance appeals matters.

I hereby certify that I qualify for:

Active (voting) Membership: Associate (non-voting) Membership:

When you click "Prepare Registration", a screen verifying our receipt will appear. Print that screen and return it with your check to:
Alice S. Mitchell, Chief
UI Appeals Tribunal
Georgia Department of Labor
1630 Phoenix Blvd., Suite 201
College Park, GA 30349
Phone: (770) 994-2220
Fax: (770) 996-6871
Email: alice.mitchell@dol.state.ga.us
Federal ID No.: 94-2768000

First/Last Name:
Title:
Agency:
Mailing Address:
City St Zip:	, .
Phone:
Fax:
Email: