LIDLA MEMBERSHIP APPLICATION

LIDLA ASSOCIATE MEMBERSHIP APPLICATION

We / I wish to support and further the aims of Long Island Dental Laboratory Association, Inc. [LIDLA], by becoming an ASSOCIATE MEMBER, and agree to abide by the Constitution and By-laws and Business Procedures of that association. This application is subject to approval by the executive board and or the members of the association. I/WE are actively involved in the Dental laboratory activities as manufacturer, distributor or supplier of goods and/or services.

Name of Firm_______________________________________________________________________

Telephone ( )___________________________ Fax ( )____________________________

Address __________________________________________________________________________

__________________________________________________________________________

Town __________________________ County ____________________ Zip __________________

Name of representative_________________________________________

Telephone__________________________________________________

Fax________________________________________________________

Pager______________________________________________________

Email_______________________________________________________

Signature of applicant___________________________________________________

Annual Dues are $95.00 per Associate member

Rules for membership

Members are required to follow and abide by the Constitution and Bylaws of the Association.
When participating in an association activity requiring payment, such payment must be sent
to the treasurer at least 10 days prior to the activity; no reservations may be made by telephone.
Members are expected to attend at least one executive board, general membership meeting, or
function organized by the association each calendar year, if practical.

Mail To:	Mail with check for one year's Dues, made out to the order of LIDLA, to:
	LIDLA
	c/o Arthur D. Wilde, Coordinator
	48-13 216th Street
	Bayside, NY 11364