Username
Email
The following information will be used in the membership directory. Please include all information you wish to appear in the next directory. Memberships are for July 1 through June 30.
First Name *
Last Name *
Municipality/Agency
Position
Email Address *
Website
Phone Number
Fax Number
Address Line 1 *
Address Line 2
City *
State * - select - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Africa / Canada / Europe / Middle East Armed Forces America (except Canada) Armed Forces Pacific
ZIP Code *
Personal information is used by ILCMA to better acquaint itself with the membership and will not be used to discriminate against any individual or group, regardless of age, race national origin, marital status, color, religion, physical or mental disability, veteran status, sexual orientation, political affiliations, or any other factor unrelated to professional qualifications or gender.
Email Address
Address Line 1
City
State - select - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Armed Forces Africa / Canada / Europe / Middle East Armed Forces America (except Canada) Armed Forces Pacific
ZIP Code
Partner’s Name
Your Gender
Your Ethnicity
Are you of Latino ethnic background? - select - Yes No
Undergraduate Degree from
Graduate Degree from
Registration confirmation will be emailed to you. After your account has been confirmed, you will need to pay your membership dues to gain full access to the website.
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