Serving the Rights of Bars, Restaurants, and their Patrons!
ADDITIONAL LOCATION
MEMBERSHIP APPLICATION
Please print our membership application and return it with payment to the address on the form, or simply fill out your information below and an ILBA represenatitive will contact you to complete the application process.

PRINTABLE ILBA MEMBERSHIP FORM
 (Adobe Acrobat Reader Required)


Please provide the following contact information:

  Name On Permit:
Name Of Business (DBA):
Permit Address:
City:
State/Province:
Zip/Postal Code:
Permit Number:
Business Phone: ext:
Other Phone: ext:
Fax:
Contact Name 1:
Contact Name 2:
Email:
Web Site:
Would you like a link to your web site from the ILBA web site? Yes
No

Please provide the following additional information:

Name Of Primary ILBA Membership Location:
Primary ILBA Membership Permit Number:
Primary ILBA Membership 
Expiration Date:		 (month, year)
Home Address:
City:
State/Province:
Zip/Postal Code:
Home Phone:
FORM SUBMITTED BY:

DUES STRUCTURE
(After the first membership at regular price)
Additional Membership Dues  $100.00/yr (Includes National and State of $75 and Local of $25)
Optional Lobby Fund $25.00/yr (Amounts larger than suggested are welcome?
Total Suggested Payment $125.00/yr (Per Additional Location)
*The above amounts will be invoiced to the address on the application.  Your ILBA Membership will go into effect upon payment of your Membership Dues.
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