ICA MEMBERSHIP APPLICATION
Family name of person applying to be ICA Member:
First name(s):
Company name:
Street:
City:
State:
Postal Code:
Country:
Telephone:
Fax:
E-Mail:

Category of business: (check one) Miner
Cutter
Wholesaler
Other

Category of membership: (check one) Regular Member $1100 entrance fee
Associate Member $1100 entrance fee
(Entrance fees include first year´s annual dues of $600)

Junior Members
Persons under the age of 30 as of 31 December may choose a membership in this class. For this class of membership the entrance fee is waived, and dues are 50% of that for the other two membership classes. Persons applying for junior membership status shall designate whether they wish to be Junior Regular or Junior Associate Members. Election and probation are the same as for the regular and associate members. The year the junior member attains the age of 30, the dues requirements get revert to those of the other membership classes.
Birthday mm/dd/yy
Junior Regular Member $300 entrance fee
Junior Associate Member $300 entrance fee
(Entrance fees include first year´s annual dues of $300)

National colored gemstone trade organization membership: Organisation:
Member Name:
Company:
Country:
Fax:

Trade references (preferably members of ICA): 1.)
Name:
Company:
Country:
Fax:
2.)
Name:
Company:
Country:
Fax:
3.)
Name:
Company:
Country:
Fax:

I, the undersigned, declare the above statements are true and in the event my application for membership is accepted by the International Colored Gemstone Association, I agree to abide by the Constitution, By-Laws, Code of Ethics and Rules laid down by the association.
Signature:(check for agreeing above)

After sending this online Form, please send business / name card, and payment to:

ICA
19 West 21st Street, Suite 705
New York, N.Y. 10010-6805, USA
Telephone: 1 (212) 620-0900
Fax: 1 (212) 352-9054

METHODS OF PAYMENT

CHECK: Payment via a check drawn against a United States bank only. Foreign checks are not accepted and will be returned.
WIRE: Bank to bank electronic transfer. Add $25 per transaction for additional bank charges.Transfer to:
For wire transfer information,
please contact the ICA head office at
ica (at) gemstone.org
ICA
19 West 21st Street, Suite 705
New York, N.Y. 10010-6805, USA
Telephone: 1 (212) 620-0900
Fax: 1 (212) 352-9054
CREDIT CARD: American Express
Master Card
Visa Card
Discover Card
SUM: $US
Card Number:
Expiration Date:
Name of Card Holder:
Name of issuing bank:
Signature:
Date:

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