Illinois College Automotive Instructors Association

Membership Form

Joining ICAIA, one of the nation's premier state automotive technology instructor associations, entitles you to receive our mailings, semi-annual newsletter, and attend any of our spectacular conferences.  A conference registration fee will need to be paid to cover additional conference expenses.  ICAIA membership dues are only five dollars a year, with one, three and five year options.  If you wish to join, just print this form, complete the information, and return it along with a check (No Credit Cards or P.O.'s) made payable to I.C.A.I.A. to:

Art Koudelka
ICAIA Executive Treasurer
Illinois Valley Community College
815 N. Orlando Smith Ave.
Oglesby, IL. 61348-9692

(Please print or type)

Name:_________________________________________________________________
School Name:___________________________________________________________
School Address:__________________________________________________________
City:_____________________________ State:________________  Zip: _____________
Phone:___________________________  Fax:__________________________________
Cell Pone: ________________________
e-mail:__________________________________________________________________

Home Address:___________________________________________________________
City:_____________________________  State:________________  Zip:______________
Phone:____________________________ Fax:___________________________________

Where do you want ICAIA mailing sent (circle one)  School or Home

Please check all areas that you teach ______Automotive  ______Collision  ______Diesel

Membership dues are five dollars a year, with a one, three or five year option.  Please circle one of the options below:

$5.00 for a one year membership in ICAIA

$15.00 for a three year membership in ICAIA

$25.00 for a five year membership in ICAIA

Thank you.