Midwest Insulation Contractors Association
7250 Poe Avenue, Suite 410, Dayton, OH 45414
Phone: 1-888-294-0084 | Email: mica@micainsulation.org | Website: micainsulation.org
MEMBER APPLICATION/PROFILE Date: _____________
Name of Company ____________________________________________________________________________________
Address _____________________________________________________________________________________________
(Street) (City) (State) (Zip)
Phone Number _____________________________ Fax Number _____________________________________________
e-Mail Address ______________________________________Website Address ___________________________________
List those members that you would like on the mailing list for MICA publications:
Name ___________________________________________ Email _______________________________________________
Name ___________________________________________ Email _______________________________________________
Type of Membership: Type of Business:
________ Contractor $775 ______Corporation
________ Manufacturer $575 (Own factories that take raw material ______Partnership
and produce products and take title to them ______Proprietorship
________ Distributor/Supplier $575 (Buy from manufacturers,
lot break, and provide delivery, etc.)
________ Fabricator $575 (Take title to products and change their
form (add value) by reworking)
________ Affiliate $575
Contractor Member Information:
Union Affiliation [ ] Identify Local ______________
Merit Shop [ ]
Type and Percentage of Work Performed:
Insulation;
Commercial ________ Abatement ________
Industrial ________ Firestop ___________
Note: Annual membership dues are
deductible for most members as an ordinary
and necessary business expense but ARE
NOT deductible as charitable contributions.
MICA is not involved in state or federal
lobbying.
ATTN: Contractors that are joining for the first time
may take $200 of f their first year of dues! Pay only $575!
Questions? email: info@micainsulation.org
Please tell us who to
thank for reffering
you to MICA:
mica messenger
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