Join the Mid-Atlantic Security Traders Association

Apply to Join the Mid-Atlantic Security Traders Association
(You will be contacted about annual dues)

Name
Date of Birth
Status	Male Female
	Married Single
Current Firm
	Date You became employed with this Firm
	Department Posistion
Please describe the nature of the trading you engage and list some of the stocks you trade or provide other pertinent information on the capacity you are employed in the securities industry.
Previous Employment
	Employed from to
	Department Posistion
	Have you ever been named in any proceeding brought by any securities self-regulatory organization, state securities regulatory commission or agency, or the Commodity Futures Trading Commission, or the Securities and Exchange Commission which found that you violated any law, rule or regulation or which imposed any disciplinary sanction against you? YES NO Has any firm with which you were associated been subject to such a finding or disciplinary sanction which was imposed on such firm directly or indirectly as a consequence of any conduct on your part? YES NO Are you or is any such firm currently subject to any proceeding in which the allegations could result in any such finding or disciplinary sanction? YES NO If you answered yes to any of the above questions, please explain in the comments section below.
Current Business Street Address
City
State
Zip Code
Work Phone
Fax
Cell
E-mail
College Attended
Date Graduated
Highest Degree
Questions/Comments
	I prefer to be contacted via: Phone Cell Phone E-mail