ICA Membership Application Member NumberContact Name*Ranch/Business Name*Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County*Phone*Email* General Member Benefits: New members receive a 12"x18" aluminum "No Trespassing" gate sign ICA membership card ICA member decal ICA bumper sticker Subscription to the Southern Livestock Standard ($20 value) Health and auto insurance opportunities Networking opportunities Local chapter meetings Timely updates on legislative and industry information. Many of these updates come instantly via EMAIL. Membership Levels:Wrangler Price: $100.00 Quantity: Includes general member benefitsRancher/Family Price: $125.00 Quantity: Includes general member benefits, gate signRancher/Family: Please indicate if you would like the gate signYesNoRound Up Price: $150.00 Quantity: Includes general member benefits, gate sign, capRound Up: Please indicate if you would like the gate signYesNoCattle Boss Price: $250.00 Quantity: Includes general member benefits, gate sign, cap, special ICA giftCattle Boss: Please indicate if you would like the gate signYesNoExtra Hand Price: $500.00 Quantity: Includes general member benefits, gate sign, cap, special ICA giftExtra Hand: Please indicate if you would like the gate signYesNoTop Hand Price: $1,000.00 Quantity: Includes general member benefits, gate sign, cap, special ICA giftTop Hand: Please indicate if you would like the gate signYesNoJunior/Collegiate Price: $20.00 Quantity: Includes general member benefits, t-shirtJunior/Collegiate - Select T-Shirt SizeSmallMediumLargeXLOptional: Donation to ICA scholarship fund in memoriam of Steffany Lynn Sklar (does not go toward dues) Votes: ICA "Wrangler" members are allowed one delegate vote. All other membership levels will be eligible for two votes with the exception of Junior/Collegiate members, which will not have voting rightsTotal $0.00 Payment Method*I will call the ICA office at 512-620-0162 with my credit card info.I will mail a check for the above total to the ICA Office at PO Box 1168, Lockhart, TX 78644I will provide my credit card details here so ICA can process the charges.Please provide your credit card details here. Please include:Type of card: (Visa, MasterCard)*Name of Cardholder:*Card Number:*Expiration Date:*ID number on back of card:*Dues to Independent Cattlemen’s Association are not deductible as a charitable contribution but may be deductible as an ordinary and necessary business expense. The nondeductible portion of dues is 15%.PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.
