ILICA Membership Application

Membership Application

Illinois Land Improvement Contractors Association, Inc.
Name*

First NameLast Name
Company Name*
Spouse's Name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Cell Phone
Fax
Email*
example@example.com
CC Email
example@example.com
Website
Date of Birth

MonthDayYear
How would you prefer to receive communications from Illinois LICA?*

EmailMail
ILICA sponsor (Who recommended you?)*
Where did you hear about ILICA?*
Example: social media, email, word of mouth

Membership Type*

Active Contractor MembershipActive members are individuals engaged in the business of entering into contracts for performing work that will result in soil, land, natural resource conservation or rehabilitation, water conservation, control and prevention of soil erosion, depletion and misuse of natural resources and soil and water pollution and contamination.

$350.00

Associate MembershipAssociate members are those businesses that manufacture or sell equipment, materials or services used by active members.

$295.00

Affiliate MemberAffiliate members are individuals employed by an active member in the business that makes the active member eligible for membership.

$85.00

Enter coupon

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card

I understand that Illinois LICA membership is contingent upon the completion of the membership application, payment, and board approval. I understand I may only use the Illinois LICA logo as a member in good standing. Upon expiration and/or termination of membership, for any reason, I will cease use of Illinois LICA’s logo and immediately remove Illinois LICA’s logo(s) in use and in reference to membership within Illinois LICA. I understand failure to do so may allow Illinois LICA to take any and all legal action against me and/or my company for unauthorized logo use and/or trademark infringement.
Please list my contact information on ILICA’s interactive “Find a Contractor” website map.
Check All Services Provided*

CH - Concrete/HardscapingCR - Crane ServicesDB - Directional BoringDW - Drainage/Water Mgmt./IrrigationEM - Earthmoving/Grading/LevelingEX - Excavating/Land ClearingGR - Gravel/Rock ProductionLS - Landscaping/Seeding/SodOD - Open Ditch Work/DredgingPD - Ponds/DamsRP - Roads/PavingSP - Site Prep./DemolitionSS - Septic Systems/Onsite Wastewater TreatmentTH - Trucking/HaulingTW - Terraces/WaterwaysUU - Underground UtilitiesOther
Check category that best describes your business (limit 2)*

AccountingInsurance AgenciesAuction ServicesIrrigation SystemsBankingLandscape WholesalerBarge UnloadingLaser/Machine Control Systems/GPSBatteries/Starters/AlternatorsLaw FirmBusiness Succession/Estate PlanningMarketing/Promotional & PrintingCommercial Buildings/ConcretePipe, Valve, Fittings & Tool SupplierConstruction SupplyPrecast Concrete StructuresContractor EducationRock/Gravel ProductionDrainage/Drainage EquipmentSafetyElectricalSeptic/On-Site-Waste SuppliersEngineering ConsultingSoil ScientistEnvironmental SupportTire Sales & ServicesEquipment Sales & ServiceTruck/Trailer FabricationErosion Control MaterialsTruck/Trailer PartsExcavation Shoring ProductsTruck/Trailer Sales & ServiceFinancial AdvisorTrucking ServicesFuel Additives/Lubricants/Paint/CoatingUsed Construction EquipmentFuel SuppliersWater Management ProductsHydraulic Hose Sales & ServicesInsuranceOther
Please verify that you are human*
Should be Empty: