2018 Annual Membership/Renewal Application www.illinois.wine.com www.illinoiswine.com Form available online at: http://illinoiswine.com/membership/become-a-member/ For questions, please contact director@illinoiswine.com, 217-726-8518 Company Hours of Name: Operation: Primary Product Business Type: Line: (i.e. winery, (i.e. wine, retailer, etc.) merchandise, etc.) Mailing City: Address: Zip Code: County: Physical City: Address: Zip Code: County: Company Website: Phone: Email: Applicants Date of Contact: Birth: Cell Phone: Phone: E-mail: Number of Full -time employees: Number of Part-time Employees: Voting Member Winery *Production over 50,000 gallons $ 300.00 Winery *Production 50,000 gallons $ 200.00 Additional Offsite *$50.00 per location, 5 and above capped at $250.00 No. of locations: $ Locations: Vineyard *1 or more acre $125.00 Non-Voting Member *Under 1 acre $100.00 (Retailer) $200.00 Affiliate Platinum $75.00 (Wine $150.00 Friend of the Affiliate Bronze Industry Bar) Wine Fan $25.00 Student $20.00 $500.00 $250.00 Allied Gold Allied Silver Payment to $ Payment Method: Online I.G.G.V.A. 1. Dues are payable through January 31 of each year. 2. Dues and Fees are Non-Refundable or Transferable. monthly late fee of 15% will be assessed January 31. 3. A Employee Name / E-mail address to receive I.G.G.V.A. monthly newsletter and workshop mailings: Name: E-mail: Name: E-mail: Please Mail Application & Dues Payment to: Illinois Grape Growers and Vintners Alliance 2900 Greenbriar Dr., Springfield, IL For Office Use Date The percentage of Illinois Grape Growers and Vintners Alliance Dues that will be Entered: Check #: non-deductible for income tax purposes in 2018 is 7%. Section 162€ of the Internal
2018 Annual Membership/Renewal Application www.illinois.wine.com www.illinoiswine.com Form available online at: http://illinoiswine.com/membership/become-a-member/ For questions, please contact director@illinoiswine.com, 217-726-8518 Company Name: Hours of Operation: Business Type: (i.e. winery, retailer, etc.) Primary Product Line: (i.e. wine, merchandise, etc.) Mailing Address: City: Zip Code: County: Physical Address: City: Zip Code: County: Company Phone: Website: Email: Contact: Applicants Date of Birth: Phone: Cell Phone: E-mail: Number of Full -time employees: Number of Part-time Employees: Voting Member Winery *Production over 50,000 gallons $ 300.00 Winery *Production 50,000 gallons $ 200.00 Additional Offsite Locations: *$50.00 per location, 5 and above capped at $250.00 No. of locations: $ Vineyard *1 or more acre $125.00 Non-Voting Member *Under 1 acre $100.00 Affiliate Platinum (Retailer) $200.00 Friend of the Industry $75.00 Affiliate Bronze (Wine Bar) $150.00 Wine Fan $25.00 Student $20.00 Allied Gold $500.00 Allied Silver $250.00 Payment to I.G.G.V.A. $ Payment Method: Online 1. Dues are payable through January 31 of each year. 2. Dues and Fees are Non-Refundable or Transferable. 3. A monthly late fee of 15% will be assessed January 31. Employee Name / E-mail address to receive I.G.G.V.A. monthly newsletter and workshop mailings: Name: E-mail: Name: E-mail: Please Mail Application & Dues Payment to: Illinois Grape Growers and Vintners Alliance 2900 Greenbriar Dr., Springfield, IL The percentage of Illinois Grape Growers and Vintners Alliance Dues that will be non-deductible for income tax purposes in 2018 is 7%. Section 162€ of the Internal For Office Use Date Entered: Check #:
2018-Membership-Application-Form..Fillable.-002.docx