Membership Application


Please complete and submit the application form below, then follow
the instructions on the next page to submit payment by check or credit card.

If you prefer, print the application form and mail with your check:
Mail-In Application Form

Business Information

Name
REQUIRED

Address

City

State

Zip

Area Code/Phone

E-Mail
REQUIRED

 

 

To keep all our members informed, RIICA would like to know how you would like to receive the monthly newsletter:

 

 By Email          By Mail

 

 

Membership Level

Individual/General Membership   $180.00
Standard membership privileges

 

 

Company Membership   $270.00
Includes membership for Owner/President/CEO and one (1) employee. The two members are entitled to all privileges and rights as Individual/General Members including the right to vote.

Owner Name



Employee Name (list one)

 

 

Qualified Company Membership   $50.00 each
(Company Membership Required)
This member must be an employee of a Company Member in good standing (dues paid in full). This member would not have voting rights. They or their family members would not be eligible for the RIICA Scholarships. They would receive all mailings and would be able to attend any and all meetings, classes, and functions at the same cost as regular members. Company members would be listed separately in directory; Qualified Company Members would be listed under the company.

Employee Name(s)

 

 

Associate Vendor Membership   $500.00

  • E-News advertisement throughout the year rotating RIICA website
  • Website link from the RIICA website including your logo and company information to your site at a click of a button
  • Advertising and sponsorship opportunities in the newsletters, special events and general membership meetings
  • Discounted rates for educational and safety seminars and events for all your employees

 

 

Youth Member   $25.00
No voting rights. Must be under the age of 18 years. Would be encouraged to help out with events when needed.

 

 

Payment Method

 

 

I will pay by: 

 Check          Credit Card or PayPal

 

 

CAPABILITY PRIDE INTEGRITY

© Copyright 2007-2022 Rhode Island Independent Contractors & Associates. All rights reserved.
PO Box 233 Exeter, RI 02822 (401) 785-1830
RIICA is a 501(c) 6 non-profit organization.

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