Primary Member Name *

First Name

Last Name

Spouse Name

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Office Phone Number

(###)

###

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Cell Phone Number

(###)

###

####

Fax Number

(###)

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Contractor Type

Please check all that apply

CR Crane Service

DI Drainage/Irrigation

EC Erosion Control

EMC Earthmoving/Land Cleaning

EXG Excavating/Grading

HD Hardscaping

LL Land Leveling

LS Landscaping

ODW Open Ditch Work

OSW On-Site Waste Treatment

PA Paving

PD Ponds/Dams

R Reclamation

SA Dealer, Service Company, Gov't Agency, Consultant, Insurance Agency

SEP Septic Systems

TH Trucking/Hauling

TW Terraces/Waterways

Membership Type

Active Contractor Member ($295 annual membership): Active Land Improvement Contractor (includes primary member and spouse, as well as National LICA membership)

Special Member ($575 annual membership): Person or company with close interest or alignment with the land improvement industry, not meeting the definition of associate member

Associate Member ($325 annual membership): Person within a company that operates as a non-profit organization, government entity, trade or professional association and/or research or academic institution with vested interest in the land improvement industry

Retiree/Honorary Member ($50 annual membership / person): Former person(s) with land implement industry experience of 10+ years, either as a contractor or supporting business, and is 55+ years young and no longer actively working within the industry