Please enclose your dues with the application and mail to: California LICA
223887 Road 4
Chowchilla, CA 93610
MEMBERSHIP APPLICATION

Company Name ___________________________________________________________________________
Member Name ____________________________________________________________________________
Address _________________________________________________________________________________
City _____________________________________________________________________________________
State __________________________________ Zip ___________________________________________
Phone ( _______ ) _______________________ Fax ( _______ ) ________________________________
Email Address ____________________________________________________________________________
Spouse's Name __________________________ (Contractor Member Only) Date of Birth _____________
Sponsor _________________________________________________________________________________
(Type of Business)
DI Drainage/Irrigation OSW On Site Waste Treatment
EC Erosion Control PA Paving
EMC Earthmoving/Land Cleaning R Reclamation
EXG Excavating/Grading PD Ponds or Dams
LL Land Leveling SEP Septic Systems
LS Landscaping TH Trucking or Hauling
ODW Open Ditch Work TW Terraces or Waterways
SA Dealer, Service, Government Agency, Consultant, Insurance Agency
Application is for (Check One)
Active Member (Annual Dues) ................................................................ $250
Active Land Improvement Contractor.
Associate Member (Annual Dues) ................................................................ $250
Person or companies manufacturing or selling materials, equipment or services to active members.
Affiliate Member (Annual Dues) ................................................................ $100
Person(s) or companies interested in CALICA

Signature__________________________________________________ Date ___________________________