ICON Annual Celebration Dinner Sign Up Form

This field is for validation purposes and should be left unchanged.

Please complete this form before November 12.
Current ICON Members (as of Oct. 31, 2025) receive one complimentary dinner admission and Good Neighbor Award winners and one guest receive complimentary dinner admissions. PLEASE RSVP without payment by emailing

Purchaser Contact Information

Name(Required)

First Last

Phone(Required)

Email(Required)

Enter Email Confirm Email

Dinner Admission and Attendee Names

Dinner Admission

For non-members and additional guests. Each dinner is $30. Please enter number of dinner admissions.

Price: $30.00

Names of Attendees

Additional Options

The following are optional – ICON Membership, Sponsorship, Donation.

ICON 2026 Individual or Organization Membership

Each membership is $25 per year. Individual Memberships include voting rights. Organization Memberships are non-voting.

Price: $25.00

Membership Details

Please enter details below (For EACH membership: whether Individual or Organization, full name, email address and Ward number.)

2026 ICON Sponsorship

Please see our Sponsor Flier for more details (opens in a new tab so you can complete the dinner payment form here.)

Annual Sponsor $350

Good Neighbor Award Sponsor $150

Combo – Annual and Good Neighbor $400

ICON Neighborhood Friend Sponsorship

Please enter a dollar amount between $75 and $149.

Make an additional donation to ICON:

Please enter the dollar amount to donate to ICON.

Subtotal

Payment

Payment Type(Required)

Credit Card

Check

Credit Card payments will be processed using Square.
After clicking “Pay Online”, enter your payment information in the secure area of the form.
ICON donations are tax-deductible.

Credit Card

Cardholder Name

Card Details

Make checks payable to ICON .
ICON donations are tax-deductible.

Mail to:
Donna Mathis, ICON Treasurer
2119 S Renfro St
Springfield, IL 62703

Total

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