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Online / Printable Label Order Form

IACLEA MEMBERSHIP MAILING LABELS RENTAL ORDER FORM

Your Order#

Buyer’s Name:

Phone:

Company Name:

Address:

City:

State:

Zip:

Email:

Purpose:

IACLEA is an institutional based membership association. The voting member usually the person with the title of Chief of Police and/or Director of Security/Public Safety. There are over 1,000 Institutional Members. If you wish to include other members on campus (Professional Members) the list expands to over 1,400. We do have other member types, such as Supporting and Affiliate Members, which increases the list to about 1,500.

1. The membership mailing labels are run in zip code order.

2. Select member type(s):

               Institutional Only
               Institutional, Professional and Associate
               All Members ( including - Affiliate, supporting and Retired members)

3. Select One:

               USA Only
               USA and Canada Only
               All Countries

You may choose a regional area, but only one region per mailing list.

	Canada		Mountain Pacific Region (AK, CA, HI, ID, MT, NV, OR, UT, WA)
	International (All countries except U.S. & Canada)		North Atlantic Region (CT, ME, MA, NH, RI, VT)
	Mid-America Region (AR, IL, IN, IA, KS, MI, MN, MO, NE, ND, OK, SD, WI)		Southeast Region (AL, FL, GA, LA, MS, NC, PR, SC, TN, VI)
	Mid-Atlantic Region (DE, DC, KY, MD, NJ, NY, OH, PA, WV)		Southwest Region (AZ, CO, NM, TX, WY)

Addresses provided are the members' preferred mailing address. Some will be home addresses and some will be business addresses. We cannot provide just one type, as we do not have both addresses for all members.

One-time Rental Fee:

Member $150 plus $.05 per name
Non-Member $250 plus $.05 per name

A price quote for renting a list will be e-mailed to you within one week of receiving the request. Payment and a copy of the mailing piece must be received by IACLEA before the request is considered complete. Mailing labels will be printed on Avery 5162 address labels and will be mailed to you via UPS 2nd Day Ground within two weeks of receipt of all required materials. Due to a policy change, mailing lists will no longer be provided via e-mail.

IACLEA MEMBERSHIP MAILING LABELS RENTAL AGREEMENT

Renter understands and agrees that IACLEA is making its mailing list ("mailing list" refers to a list in either discr or electronic format) available to renter on a ONE-TIME ONLY basis and solely for renter’s use as stated under "Purpose". Any other use of the mailing list is specifically prohibited unless IACLEA grants permission for such use in writing and renter pays the appropriate fee for such use.
The mailing list renter shall use the mailing list provided by IACLEA only for pre-approved promotional mailings. The renter shall treat IACLEA’s membership list and all mailing labels as confidential information. The renter shall not under any circumstances sell, loan, or circulate such membership lists to any third party, or use such membership lists for any other purpose.
The mailing list renter agrees that in utilizing IACLEA’s membership list, he/she will not disclose, transfer, duplicate, reproduce or retain any portion of the list in any form, by photocopying, entering into a database, or otherwise duplicating by any means
The mailing list renter agrees to reimburse IACLEA for all costs which IACLEA may incur in enjoining unauthorized parties from using the membership list in all cases where such unauthorized parties gained access to the membership through the renter listed below or any of the renter’s agents or employees.
The mailing list renter agrees IACLEA will have the right to monitor the use of the membership list.
The mailing list renter agrees that the promotional piece supplied for approval with this agreement is the piece(s) that will comprise the mailing. Membership Mailing Labels Order will not be sent until a copy of the promotional piece is received at IACLEA Headquarters by mail, by fax or by email attachment.
Signature below indicates complete acceptance of the above conditions and constitutes a contract between IACLEA and the above stated mailing list renter.
Renter will make no claims that the mailing is in any way endorsed by IACLEA without prior written approval of IACLEA.
A signed copy of this agreement must accompany mail in or faxed orders.
We will contact you with an order number and a price quote based on your selections upon receipt of this order. Payments must be sent after order quote is accepted, using our printable/online form. Order will not be filled until payment is received. We are sorry but we do not accept purchase orders for mailing list rentals nor do we invoice. We accept checks made payable to IACLEA or credit card payments (VISA, MasterCard, or AMEX). You may obtain a price quote by telephoning 860-586-7517 ext 554, faxing a completed copy of the order form to 860-586-7550, or emailing a completed order form to info@iaclea.org. Quotes are good for orders received within 30 days of the price quote.

Please enter text in image: (this allows us to prevent machines from filling out this form automatically)

If ordering online, fill in this form and click this button to send your order. By doing so, you are signing your form electronically and certifying that you read, and agree to the terms stated above.

If mailing or faxing your order, be certain all information is filled in above, print your form, sign at the bottom and mail to:

Membership Services Coordinator IACLEA
342 North Main Street
West Hartford, CT 06117-2507
Fax: (860) 586-7550
Email: membership@iaclea.org

Authorized Signature: _________________________________________________

Date: __________________