Springfield ICON Membership - Springfield ICON

Contact Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax

Email(Required)

Enter Email Confirm Email

Springfield Ward Number(Required)

Name of Alderman

Issues of Interest

What ICON issues are of interest to you?

Neighborhood Association or Organization (if applicable)

Name of Association

Association Contact

Association Phone

Association Email

Association Website

Membership Type

Membership renewals are due in January of each year.

Please register me for(Required)

$25 Annual Individual Member (1 vote)

$25 Annual Organization Member (non-voting)

$200 Lifetime Individual Member (1 vote)

$200 Lifetime Organization Member (non-voting)

Payment Type(Required)

Please note: Square charges us a fee of about 3% per transaction. We welcome your optional donation to cover the cost – or simply to support our work, or you could send a check instead. Either is optional.

Credit Card

Check

Make an additional donation to ICON:

(OPTIONAL)

Credit Card payments will be processed via Square.
After clicking “Submit Membership Application”, a popup window from Square will display for you to complete payment.
ICON membership is tax-deductible.

Make checks payable to ICON.
ICON membership is tax-deductible.

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

Total

Membership Agreement

Do you support ICON’s mission to improve the quality of life for Springfield neighborhood residents?(Required)

Yes, as a member, I support ICON’s mission to improve the quality of life for Springfield neighborhood residents.

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Credit Card

Cardholder Name

Card Details

Name

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