Membership Form

I-CAR Regular Membership Request Form

Member dues must be received, or post marked no later than December 31 of the prior year to be eligible to vote in the following membership term. No such member status will be effective until member dues are received.

*Type of Membership

* Organization Name

* Industry Segment

If Collision Repair, is there more than 1 location?

Yes No

* Mailing Address

(primary if more than 1 location)

* City

* State

* Zip

* Phone

* Designated Voting Rep

* Title

* Email

* Phone

Who should renewal invoices be sent to? (if different from above)

Name

Title