| Community Bankers of Iowa (CBI) | Des Moines, IA - Community Bankers of Iowa

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Name *

First

Last

Title *

Phone Number *

Date of Original Certification *

Email *

Date of Last Renewal (if applicable) *

Bank Name *

Bank Address *

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City

State

Zip Code

Country

If your name or affiliation is different from that at the time of certification or the last renewal, please indicate your address at the time of your last report.

Previous Bank Affiliation - Address *

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City

State

Zip Code

Country

Renewal must be submitted no later than Friday, August 23, 2019.

The fee is $25 for CBI members and $50 for prospective members. All fees must be paid at the time of renewal application.

I certify that the attached information is complete and accurate to the best of my knowledge.

I understand that the CCL™ Steering Committee reserves the right to revise or update the renewal requirements and other material and that it is my responsibility to be aware of the CCL™ current requirements. I further understand that I am obligated to inform the CCL™ Steering Committee of changed circumstances that may affect my renewal application.

I understand and agree CCL™ certification does not constitute the CCL™ Steering Committee’s warranty or guarantee of my fitness or competency to practice as a community lender. I authorize CCL™ Steering Committee to include my name on a list of certified individuals and agree to use the CCL™ designation and related CBI trade names, trademarks, and logos only as permitted by CCL™ policies. I further understand and agree that the CCL™ Steering Committee may also use anonymous and aggregate application and examination data for statistical and research purposes.

Submission of this form constitutes your agreement of these policies and serves as an electronic signature.

Name *

First

Last

Date *

Submit Your Renewal Application

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