ILPPMA: Membership Application

Join ILPPMA.

Please fill-out and submit the form below.
Enclosed a printed copy of this form with your payment.
Mail all materials to:

Illinois Pavement Preservation and Maintenance Association
Box 116
Peoria, IL 61650


Personal Information.
Contractor/Supplier/or Buyer Agency:	Contact Person:
Address One:	Address Two:
City:	State:	Zip Code:
Work Phone Number:	Work Fax Number:
E-mail Address:

Type of Membership.
Select Membership: Contractor Membership - $6,000, plus job extras Affiliate Membership - $1,000 Government Membership - No Fee

Business Information.
Type of Work/Service Your Company Performs:
Pavement Preservation Technique Used:
Are You an Illinois Prequalified Contractor? Yes No

Print two copies of this form before you click Submit. Send one copy to the address above.