Membership Application - Indiana Chamber Executives Association

'ICEA membership proves to be the most beneficial investment that our chamber makes each year.'

That's what one chamber president had to say. Investing in ICEA membership pays off for your chamber's professional staff. Don't delay another day - complete the membership application and return it with payment ASAP to start tapping into the vast array of benefits offered only to ICEA members.

Organization Information (to be displayed online)

Organization Name *

Address 1 *

Address 2

City *

State *

Zip *

Phone *

Fax

Website

Email *

Main Contact

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip *

Title

Phone *

Email *

Additional Staff Positions Included in this Membership

Billing Address (if different)

Street

City

State

Zip

Mailing Address (if different)

Street

City

State

Zip

Additional Information

Referring Chamber

Year You Began Paid Chamber Work

Membership Investment

Investment for ICEA Membership: *
(Cost of membership is based upon
Chamber annual operating budget)

Primary Directory Category *

Number of Chamber Members:

Chamber Budget:

Annual Membership Investment

Total: $

The contents of this box are for testing purposes. This box will be removed when the form goes live.
Full-Time Employees
Part-Time Employees
Hotel/Motel Rooms
Restaurant Seats
Additional Associates
Additional Associates Cost
Additional Locations
Additional Locations Cost
Assets
Assets Cost
AdditionalCategories
Additional Categories Cost
NumberOfAdditionalCategories
additionalItem1Cost

Annual Dues (charged to card)
Tax (charged to card)
Fee (charged to card)

tempValueForDropDown1

Additional Directory Categories

Primary Directory listing is complimentary
Up to two additional Directory listings are complimentary
After two, additional Directory listings are $35 each

**Hold CTRL on your keyboard to select multiple categories**

Number of Part Time Employees:

Number of Rooms (Accommodations):

Number of Seats (Restaurants):

Number of Associates (Realtors, Attorneys):

Number of Locations ($35/add. location):

Enhanced Membership ($50):

Additional Categories Cost

One-Time Application Fee

Tax

Payment Type *

NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks.

Credit Card Information

Credit Card Type * MastercardVisaDiscoverAmex

Credit Card Number *

Name On Card
Security Code
Valid Through
	Use Address Above
Credit Card Address 1
Credit Card City
Credit Card State
Credit Card Zip
Credit Card Phone Number
Credit Card Email Address

Please click submit only one time. The transaction may take several seconds.

Membership Application - Indiana Chamber Executives Association .wc-legacyPageTitle, .GeneralHeader, .HeaderStyle1, #wc-eventDetailsPageTitle, #wc-eventRegistrationPageTitle { display: none!important; }

Membership Application - Indiana Chamber Executives Association