Louisiana Chemical Association – LCIA

Membership Application

One American Place, Ste 2040, Baton Rouge, LA 70825
(225) 383-7791 fax: (225) 334-0642

Download printable form

Company Name *

Mailing Address *

City *

State *

Zip *

Parish *

Phone *

Fax

Website Address

Email *

# of Employees in Louisiana

(Fulltime and Year-Round Contract)

LCIA Dues Schedule (Choose One):

Gross Sales in Louisiana *

Annual Dues

$1,250
$1,000
$750
$500
$250
$125

# Free Listings
(includes primary contract)

Directory Listings

Each company designates one Primary Contact for billing purposes and is encouraged to list others in the directory, some of which may be free (as shown above). Beyond the free listings, additional names can be added for $30.00 per person, per year. In addition, you may provide additional contacts for meeting notifications at no charge (please provide under separate e-mail).

Primary Contact:

Name

Title:

Additional Contact Names: (if address, phone or fax number is different from above company information, please e-mail separately)

Name

Title

Name

Title

Name

Title

Name

Title

Name

Title

Once the LCIA office receives your application, we will process your application and mail you a dues invoice. To pay for your Annual Dues and Additional Listings with a VISA, MasterCard or American Express card, by phone please call Lisa Pulizzano at 225) 383-7791or click below to submit online.

Do you know a company that would benefit from joining LCIA? Please provide us their address and we will send them an information packet.

LCA

Join LCIA Now

Membership Application

LCIA Dues Schedule (Choose One):