Member Application and Renewal Form
  1. Fields with an asterisk (*) are required.

    Use this form ONLY if you wish to pay online now for your application.

    New members: fill in fields as needed.
    Renewing members: fill in any changes to current listing. If no changes are submitted your listing will be the same as last year.
  2. Company Name(*)
    Please type your full name.
  3. Contact Name(*)
    Please type your full name.
  4. Title
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  5. Address (Street Number, Address, City, Zip)
    Invalid Input
  6. Phone
    Invalid Input (123-456-7890)
  7. Cell
    Invalid Input (123-456-7890)
  8. Fax
    Invalid Input (123-456-7890)
  9. E-mail
    Invalid email address.
  10. Website
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  11. Description about your organization (max 400 characters)
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  12. 0/400 characters used
  13. How long have you been in business providing this service/product?
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  14. Please list associations /organizations in which you hold memberships
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  15. LVAIP Referring Member
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  16. Business Reference 1 Name
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  17. Business Reference 1 Company
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  18. Business Reference 1 Address (Street Number, Address, City, Zip)
    Invalid Input
  19. Business Reference 1 Phone
    Invalid Input (123-456-7890)
  20. Business Reference 2 Name
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  21. Business Reference 2 Company
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  22. Business Reference 2 Address (Street Number, Address, City, Zip)
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  23. Business Reference 2 Phone
    Invalid Input (123-456-7890)
  24. Comments
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  25. Annual Membership dues: $145.
    Membership provides one listing in the Annual Resource Guide and all other rights and privileges of membership. Joining after resource guide printing, member listing will display online and dues will be prorated.
    New members: If joining after the enrollment period that ends on June 30, your dues are prorated as follows:
    Enrolling within Jul-Sep $115
    Enrolling within Oct-Dec $90
    Enrolling within Jan-Mar $60
    Enrolling within Apr-Jun $30
    Please choose the appropriate amount from the drop down list below.
  26. Membership(*)
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    Membership
  27. Total Price
    0 USD
  28. Please Note: You do not have to have a PayPal account to pay for your tickets.
    Paypal will accept your payment method without needing a PayPal account.

  29. Anti-Spam(*)
    Anti-Spam
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