Company Name
_____________________________________________________________________________________
Member Name 
_____________________________________________________________________________________
Address 
_____________________________________________________________________________________
City 
_____________________________________________________________________________________
State 
________________________________________		 Zip 
______________________________________
Phone 
( _______ ) ______________________________		 Fax 
( _______ ) ____________________________
Email Address
______________________________________________________________________________________
Spouse's Name 
________________________________________		 (Contractor Member Only) Date of Birth _______________________________________
Sponsor _______________________________________________________________________________________
(Type of Business)
DI Drainage/Irrigation OSW On Site Waste Treatment
EC Erosion Control PA Paving
EMC Earthmoving/Land Cleaning R Reclamation
EXG Excavating/Grading PD Ponds or Dams
LL Land Leveling SEP Septic Systems
LS Landscaping TH Trucking or Hauling
ODW Open Ditch Work TW Terraces or Waterways
SA Dealer, Service, Government Agency, Consultant, Insurance Agency
DUES: The budget of the association is financed primarily by yearly membership dues which are determined by the following schedule. The annual dues for a new member shall be $235.00 for the first year. 
Application is for (Check One)
BUSINESS GROSS INCOME:
$0 to $150,000 ................................................................ $235.00
$150,000 to $200,000 ................................................................ $285.00
$200,000 to $250,000 ................................................................ $345.00
$250,000 and over ................................................................ $395.00
Active Land Improvement Contractor.
Associate Member (Annual Dues) ................................................................ $150.00
Person or companies manufacturing or selling materials, equipment or services to active members.
Sustaining Members (Annual Dues) ................................................................ $ 25.00
Retired contractors who have been members 

Signature_______________________________________________________ Date ___________________________