International Credit Executives Group
Membership Application Form

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Please fill out this form to join the International Credit Executives Group. Membership dues for the year 2008-2009 are $465. If you require a copy, print the form before clicking the Submit button. If you prefer, you can mail the form to: ICE, c/o WCA, PO Box 510157, New Berlin WI 53151-0157 or fax to 262-827-2899. Please call Dianna Rowinski with any questions at 262-827-2880 X225.

Company:

Address:     City:    State: AL AK AR AZ CA CO CT DE DC FL GA HI IA ID IL IN KS KY LA MA ME MD MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    Zip:
Phone:         Fax:  
Email:      

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Main Contact Name:        Title: Check all that apply: CBA CBF CCE CCP CICP CICECPC
Please list additional contacts (include title and email addresses):

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Annual dues in the International Credit Executives Group are $465

Payment Method: Invoice my company Check Enclosed (or in the mail) Credit Card (call 262/827-2880 or fill out information below)

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Credit Card Payments Only
Please note that this is not a secure site. You may submit information via this form, however ICE/WCA assumes no liability. You may also call the WCA office at 262-827-2880 or fill out the form, print it, and fax to 262-827-2899.

Type of card: VISA MASTERCARD DISCOVER AMERICAN EXPRESS
Name on card:   
Billing Address:      City:   State: AL AK AR AZ CA CO CT DE DC FL GA HI IA ID IL IN KS KY LA MA ME MD MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    Zip Code:
Card Number:        Expiration Date:

Checking here indicates that you authorize WCA to process your credit card for payment of membership:



By applying for ICE Group membership, member company and its representatives agree to adhere to the Rules & Procedures of the International Credit Executives Group of Wisconsin.

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