Springfield ICON PAC Membership Contact InformationName(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)FaxEmail(Required) Enter Email Confirm Email Springfield Ward Number(Required)12345678910outside SpringfieldName of Alderman Issues of InterestWhat ICON issues are of interest to you?Neighborhood Association or Organization (if applicable)Name of Association Association Contact Association PhoneAssociation Email Association Website Membership TypeMembership renewals are due in January of each year.Please register me for(Required) $20 Annual Individual Member (1 vote) $50 Annual Organization Member (non-voting) $100 Annual Business Member (non-voting) $200 Lifetime Individual Member (1 vote: $20 x 10) Payment Type(Required)Please note that PayPal charges a fee of about 3% per transaction. For online payment, we add the fees to our regular membership dues. If you prefer to avoid these fees, please send a check. Credit Card Check Make an additional donation to ICON (PayPal fee will be added):(OPTIONAL) Covering the PayPal Fee Price: $0.00 Make an additional donation to ICON:(OPTIONAL) Credit Card payments will be processed via PayPal. After clicking "Submit Membership Application", you will be redirected to PayPal to complete payment. ICON membership is not tax-deductible. A copy of our report filed with the State Board of Elections is (or will be) available on the Board’s official website (www.elections.il.gov) or for purchase from the State Board of Elections, Springfield, Illinois.Make checks payable to ICON PAC. ICON membership is not tax-deductible. A copy of our report filed with the State Board of Elections is (or will be) available on the Board’s official website (www.elections.il.gov) or for purchase from the State Board of Elections, Springfield, Illinois. Mail to: Carol Kneedler, ICON Treasurer 2016 S 4th St Springfield, IL 62703Total Membership AgreementDo you support ICON’s mission of to improve the quality of life for Springfield residents in inner city older neighborhoods?(Required) Yes, as a member, I support ICON’s mission of to improve the quality of life for Springfield residents in inner city older neighborhoods. CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
