logo-text.gif (2896 bytes)  Associate Membership application

Please complete the application form, print it out, and mail your dues payment with the application to: IACS, Station A - Box 2245, Champaign, IL 61825.  The online submission is incomplete until payment of dues are received at IACS.
Annual dues (July 1-June 30) for Associate Membership is $70.00.

Company Name Date
Street
City
State   Zip
Phone #s Fax #
E-mail
Web site address
Illinois Sales Rep
Street
City
State   Zip
Phone #s
Fax #
E-mail
Where does correspondence need to be sent?
When was your firm established?
Type of merchandise
NACS member?       If yes, ID# 
Do you sell to college stores exclusively?
If not, to what other trade(s) do you sell?
Do you or any subsidiary of yours sell through student agents?

Applicant must have a reputation for fair and ethical business practice. Please list five stores, preferably members of IACS, with whom we may check. Also, include the name of the individual to contact and complete mailing address:

          

Reminder: Online submission is incomplete until dues are received at IACS

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