Missouri LICA Contractor Membership Application/Renewal

Missouri LICA Contractor Membership Application/Renewal
Thank you for renewing your membership in
Missouri LICA!

Please update any contact information as needed.
Contact Name:*

First NameLast Name
Company Name:*
Phone:
Please enter a valid phone number.
Cell Phone:*
Please enter a valid phone number.
Email:*
example@example.com
Maiing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Spouse's Name:

First NameLast Name
Missouri County:*
Website (if applicable):
example@example.com
Birth Date:

MonthDayYear
Date
How did you hear about Missouri LICA?
Work Categories (check all that apply):*

Concrete/HardscapingCrane ServiceDirectional BoringDrainage/Water Mgmt./IrrigationEarthmoving/Grading/Land LevelingExcavating/Land ClearingGravel/Rock/Sand ProductionLandscaping/Seeding/SodOpen Ditch Work/DredgingPonds/DamsRoads/PavingSite Prep./DevelopmentSeptic Systems/Onsite Waste TreatmentTrucking/HaulingTerraces/WaterwaysUnderground Utilities
Equipment (Check all that apply):

BackhoeCrawler LoaderCraneDirt PanDraglineDozerDump TruckExcavatorGraderHydraulic DredgerLand PlaneLoaderMarine EquipmentScraperSkid SteerTrencher
Terms of Membership*

Payment by Credit Card*

Contractor MembershipAny person engaged in owning and operating construction equipment in the field of land improvement . A contractor membership includes membership in a state district; the state chapter; the National Land Improvement Contractors of America (National LICA), and the National LICA Region IV.

$350.00

Auxiliary MembershipAny spouse of a LICA member. The Auxiliary membership fees support the scholarship fund, as well as Auxiliary activities.

$15.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Credit Card

Should be Empty: