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MEMBERSHIP APPLICATION
Please fill in the form below and submit your payment via PayPal. For other options, you can download the membership application.
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Company Name:
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Referred By:
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Member Name:
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Title:
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Principal/Owner:
(if different than member of record)
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Phone:
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Fax:
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Email:
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Address:
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City:
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State:
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Zip:
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Country:
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Website:
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Shipping Address:
(If different from above)
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City:
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State:
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Zip:
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Country:
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UserName:
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Password:
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MEMBERSHIP TYPE: Please check the category that best describes the business listed above for posting on the web site,
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DETAIL BUSINESS OPERATOR ($50)
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Fixed Location Mobile w/Car Wash Auto Dealer
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Other (explain)
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Check additional services that you provide:
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Paint Touch Up Paintless Dent Repair Interior Repair Windshield Chip Repair
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Other
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Total # of Locations:
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In which town(s) is your business(es) located?
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DISTRIBUTOR MEMBER ($100)
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Briefly describe your products for posting in the web site.
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MANUFACTURER/SUPPLIER MEMBER ($250)
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Briefly describe your products for posting in the web site.
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CONSULTANT MEMBER ($500)
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Briefly describe your services for posting in the web site.
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Briefly describe member benefits you would like IDA to offer.
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Briefly describe projects/issues that you would like IDA to undertake.
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Please check the IDA committees or activities in which you might like to get involved.
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Advisory Committee Nominating Committee Bylaws Committee Membership Committee
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Other
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