SIFMA Broker Dealer Membership Application

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Contact Information For Organization
Full legal name of organization: Corporate headquarters street address:
City:
Country:
State:
Zip/Postal Code: Phone:
Fax: WebSite:
Primary/Proxy Contact
List the contact that will be responsible for introducing SIFMA Membership benefits to his/her colleagues and send across updates to SIFMA Member Engagement team on changes in personnel, or changes of interest.
Office address is the same as corporate headquarters address.
First Name:
Last Name:
 Title:
Department: Address:
City:
Country:
State:
Zip/Postal Code: Phone:
Fax: Email Address:
Dues Contact
If the same as above, please click here
List the contact at your firm that will be responsible for approving Membership fees and /or upgrades. If we should forward the invoice to a person other than the individual approving Membership fees, please note below.
Mailing address is same as organization.
First Name:
Last Name:
 Title:
Department: Address:
City:
Country:
State:
Zip/Postal Code: Phone:
Fax: Email Address:
General Counsel Contact
List your firm's General Counsel/Head of Regulatory Affairs contact.
Mailing address is same as organization.
First Name:
Last Name:
 Title:
Department: Address:
City:
Country:
State:
Zip/Postal Code: Phone:
Fax: Email Address:
Business Continuity Planning (BCP) Contact
List your firm’s BCP contact; mail groups are also permitted. In the event of natural disaster or other unforeseen circumstances affecting operations in global financial hubs, SIFMA and/or the GFMA will communicate critical information with regards to business continuity and contingency plans.
Mailing address is same as organization.
First Name:
Last Name:
 Title:
Department: Address:
City:
Country:
State:
Zip/Postal Code: Phone:
Fax: Email Address:

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