NJ Landscape - NJLCA Membership Form

MEMBERSHIP APPLICATIONNew Jersey Landscape Contractors Association465 Boulevard Elmwood Park, NJ 07407Phone: (201) 703-3600 - Fax: (201) 703-3776www.njlca.org - email: gwoolcott@njlca.orgFirm Name ____________________________________________________________________Company Rep ________________________________Title ____________________________Address ______________________________________________________________________City ____________________________________State ______________Zip ______________Phone____________________________________Fax __________________________________Email ____________________________________PAYMENT by: ? Check ? Credit Card Amount: $ ____________________________Check No. __________________________ Please make check payable to NJLCACredit Card: ? Mastercard ? Visa ? American Express ? DiscoverCard Number ____________________________________________Exp. Date ______________Signature ______________________________________________Dues to NJLCA are not deductible as a charitable contribution for federal income tax purposes, but aredeductible as an ordinary and necessary business expense.I hereby apply for:Landscape Contractors, please indicate types of service performed:? Residential Lawn Maintenance? Residential Snow Removal? Commercial Lawn Maintenance? Commercial Snow Removal? Pesticide Applications - Turf? Pesticide Applications - Trees? Residential Landscape Construction? Commercial Landscape Construction? Tree Pruning? Wall Installation? Tree Removal? Patio / Paver Installation? Stump Grinding? IPM Consulting? Landscape Design? Landscape Lighting? Residential Irrigation Installation? Commercial Irrigation Installation? Other ____________________________? REGULAR MEMBER. An individual or firmactively engaged in landscape contracting. Yourgross volume of sales determines dues.CLASS ANNUAL DUES? Above $750,000 $375? $350,000-$750,000 $275? $100,000-$350,000 $195? Under $100,000 $1451) Sales HICL# ____________2) Pesticide License # ____________3) Applicant must be able to provideCertificate of Insurance? ASSOCIATE MEMBER. $275. An individual orfirm which supplies products or services to the land-scape industry.? AFFILIATE MEMBER. $145. An individual orfirm that does not derive any income from the land-scape industry. A landscape contractor who residesand works outside the state of NJ may be grantedan affiliate membership.? STUDENT MEMBER. $75. An individual who iscurrently enrolled as a part-time or full-time student.Must provide a copy of current student I.D. Studentmembers are not eligible to vote.