MEMBERSHIP APPLICATION
General Information  
 Shop Name:

 Contact's Name:

 Address:

 City:   State    Zip:

 Phone:    Fax:

 

Questionnaire   Please fill out the following questionnaire.  Which issues are most  
  important to your.  Rate 1-8, 1 being the most important.
 
   Environmental

   OEMs vs Aftermarket

   Employee Benefits

   Paint Material Tax
 

    Steering

   Staff Training

   Technical Training

   Other:

  

   Comments:
  
 

Payment  
Repair Facility: (includes owner in fee)

0-3 employees -- $250
4-8 employees -- $450
9-14 employees -- $650
15 and over -- $850

 Vendors:

1 location -- $500
2-4 locations -- $1,000
5-10 locations -- $1,500
11 and over -- $2,000

Free Membership for vocational instructors

Checks payable to ICRA

 Charter dues paid by Nov 1, 2005 will be effective until Dec 31, 2006. You will receive a charter membership
plaque once your dues are paid.