ICES Membership Form

If you are under the age of 14, click here.
Membership Information:

Name:     ________________________________________________

Address 1:    _____________________________________________

Address 2:    _____________________________________________

City:    _________________   State/Prov:  ______________________

Country:    ______________   ZIP/Postal Code:  __________-_______

Phone:    _______________   Email Address: ___________________

Membership Type:

New Membership Renewal Membership

U.S.--$60.00 per year
       (Dues include $24.96 for your subscription to the ICES Newsletter.)
U.S.--$156.00 for 3 years
       (Dues include $24.96 per year for your subscription to the ICES Newsletter.)
International--$75.00 per year (in US funds)
       (Dues include $55.44 per year for your subscription to the ICES Newsletter.)
International -- $201.00 for 3 years (in US funds)
       (Dues include $55.44 per year for your subscription to the ICES Newsletter.)
Charter--$20.00 per year
       (Charter members are members who have joined before September 1, 1977.)
 Associate--$25.00 per year
       (An Associate Member must reside with or work for a charter or regular member and
        use the charter or regular member's address. Associate members have all the rights
        and privileges of regular members, but do not receive the newsletter or representative's mailings.)

How many years of membership would you like to pay for?____

Payment Information:

Visa              MasterCard        Discover   Check (US funds)

Card Number:  __________________________     Expiration Date (mo/yr):   ____/_______

Signature:   _______________________________________________________________

Print & Mail Completed Application to: ICES Membership          or for faster processing Mail to:Gayle McMillan or FAX to:  
(Make checks payable to ICES) Mail Box Etc.                                             Membership Coordinator 318-746-4154  
  PMB 166                                                    4883 Camellia Lane    
  1740 44th Street, SW                                Bossier City, LA    
  Wyoming, MI  49509, USA                                                 71111-5424