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ILCSWMA MEMBERSHIP APPLICATION - 2023 MEMBERSHIP
MEMBERSHIP FORM
Please fill out this form and submit.
1.
Organization
2.
Title
3.
First Name
4.
Last Name
5.
Address
6.
City, State, Zip
7.
Phone Number
*
8.
Email Address
(Required.)
*
9.
ILCSWMA Membership Options (all memberships include all staff in your agency)
(Required.)
Member - $130
Affiliate Member - $100
New Member Rate for 2023 - $30 (must have not been a member for two years or more)
Retiree Affiliate Rate for 2023 - $25 (must be a retiree from the field)
*
10.
Payment
(Required.)
Credit Card (Electronic Invoice Emailed Via Pay Pal within 2 business days)
Check (Mail to ILCSWMA, 3764 State Route 13/127, c/o Rebecca Tracy, Pinckneyville, IL 62274)
