Registration Form - Mentor Individual If you are currently registered on AML-ology to any membership, please log in before continuing this application.Primary Email (where you will receive newsletters, surveys, notifications)* Prefix- Select One -Mr.Mrs.Ms.Miss.First Name*Last Name*Nickname*This is the display name that will show in forum posts.Company Name*Title*- Select One -BSA/AML/OFAC Compliance ManagerBSA/AML/OFAC Compliance OfficerChief Compliance OfficerChief Executive OfficerChief Financial OfficerChief Information Security OfficerChief Operating OfficerChief Risk OfficerCompliance AnalystCompliance ManagerCompliance OfficerConsultant/VendorGeneral Manager/PresidentIT/Application SupportIT ManagementOther C-Level ExecutiveOtherPlease List Your Title*AML-ology Mentor membership is reserved for financial service providers and law enforcement only. Consultants, vendors, and other competitive entities are not eligible for Mentor membership. I certify that the information I will enter within on this application is true, that I am employed by a financial service provider, and that I have used my business email for this application. I agree that my application will be reviewed and verified by AML-ology.* I agree to the following terms:AML-ology Mentor membership is reserved for financial service providers and law enforcement only. Consultants, vendors, and other competitive entities are not eligible for Mentor membership. I certify that the information I will enter within on this application is true, that I am employed by a financial service provider, and that I have used my business email for this application. I agree that my application will be reviewed and verified by AML-ology.Business Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Business Phone*Home Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Secondary PhoneSecondary Email This field is hidden when viewing the formWhich email address would you like to receive email notifications?* Business PersonalWhich of the following is your institution’s primary regulator?*- Select One -FDICOCC Licensed/CharteredState Licensed/CharteredNCUASEC/FINRAIRSOtherList your institution’s primary regulator.*Asset Size*- Select One -Under $500 Million$500 Million - $999 Million$1 Billion - $9 Billion$10 Billion - $24 Billion$25 Billion - $49 Billion$50 Billion - $250 BillionOver $250 BillionN/AWhich of the following certificates have you obtained and actively maintain? (Select all that apply. To select multiple: hold Ctrl, then select each item)*BAICAFPCAMSCAMS-AuditCAMS-FCICAMS-SanctionsCCRPCFCSCFECPACRCMOtherN/APlease List Your Professional Certification*Years of Experience in AML*- Select One -Brand new1-5 years6-10 years11-20 yearsOver 20 yearsN/aStates of Operation*- Select One -12-1011-3031-50Outside of the 50 statesNumber of Branches*- Select One -1-56-1516-3031-50More than 50Core Processor (Select all that apply. To select multiple: hold Ctrl, then select each item)*COCC/DMACorelation – KeystoneFinastraFIS – Miser, Insight, HorizonFiserv – DNA/Premier, Precision, ClearTouch, etc.Jack Henry – Silverlake, Episys, 20/20, etc.OSITotalPlusOtherPlease specify your core processor.*BSA/AML Software (Select all that apply. To select multiple: hold Ctrl, then select each item)*NoneProprietary/In-HouseAbrigo (BAM, BAM+, Bankers Toolbox)ActimizeAMLcheckBiz4xClear ViewCRB MonitorFileInviteFiserv – FCRM/AML ManagerML VerifyPatriot Officer – Global VisionPrime Compliance SuiteProcessGeneSAS AMLToken of Trust ID VerificationVerafinYellow HammerOtherPlease specify your BSA/AML software.*Is your institution insured by the FDIC?*- Select One -YesNoN/AUsername*Password* Enter Password Confirm Password Strength indicator MembershipCAPTCHA
