1 Start 2 Org Info 3 Contacts 4 Leadership 5 Background 6 Relationships 7 Complete FORM INSTRUCTIONS This form collects key details about your firm that help FIA evaluate your application for membership. It takes approximately 10 minutes to fill out the form. You cannot save the application so please have the following details ready before you start: Organization Information • Contact information • Business Description: brief overview of your firm/who you are/what you do Organization Name • Applicant Contact Information (i.e. the individual filling out the form) • Billing Contact Information Leadership • Name / Title / Phone / Email for two individuals in leadership roles at your firm (ex. Principals, Partners, Owners, Presidents, CEOs, Board Chairmen) Background Where applicable details about: • Membership in exchanges, other trading venues or clearinghouses • Registration with governmental agencies and self-regulatory organizations • Criminal or disciplinary actions Relationships • Short list of organizations that you do business with in the listed derivatives industry If you have access to all the above information, please click Next Page below to start the form submission.