2018 Membership Information Form | Indiana Township Association

2018 ITA Membership Information Form

Please fill out the form with your Township office information.

After filling out the form, you will receive payment instructions.

Trustee Name:*

(Legal Name-what is on your Social Security Card for our Database)

First Middle Initial Last

Trustee Preferred First Name for Tags:

Email:*

Phone:*

Alternate Phone:

Fax:

Township:*

County:*

Address:*

Street Address Address Line 2 City State ZIP Code

Party:

Democrat
Republican

Date started:

Number of years in office:

Trustee Office Hours:

Your Senator(s)

Your Representative(s)

Method of payment:*

If you select "Online credit card or check" you will be redirected to the payment form after submitting this form.

Township Board Members Information Only

Board Member 1:

Name:*

Preferred 1st Name for Name Tags

Email:

Phone:*

Address:*

Street Address Address Line 2 City State ZIP Code

Party:

Democrat
Republican

Date started:

Number of years in office:

Board Member 2:

Name:*

Preferred 1st Name for Name Tags

Email:

Phone:*

Address:*

Street Address Address Line 2 City State ZIP Code

Party:

Democrat
Republican

Date started:

Number of years in office:

Board Member 3:

Name:*

Preferred 1st Name for Name Tags

Email:

Phone:*

Address:*

Street Address Address Line 2 City State ZIP Code

Party:

Democrat
Republican

Date started:

Number of years in office:

More than 3 Board Members?

Board Member 4:

Name:*

Preferred 1st Name for Name Tags

Email:

Phone:*

Address:*

Street Address Address Line 2 City State ZIP Code

Party:

Democrat
Republican

Date started:

Number of years in office:

Board Member 5:

Name:*

Preferred 1st Name for Name Tags

Email:

Phone:*

Address:*

Street Address Address Line 2 City State ZIP Code

Party:

Democrat
Republican

Date started:

Number of years in office:

Board Member 6:

Name:*

Preferred 1st Name for Name Tags

Email:

Phone:*

Address:*

Street Address Address Line 2 City State ZIP Code

Party:

Democrat
Republican

Date started:

Number of years in office:

Board Member 7:

Name:*

Preferred 1st Name for Name Tags

Email:

Phone:*

Address:*

Street Address Address Line 2 City State ZIP Code

Party:

Democrat
Republican

Date started:

Number of years in office:

Email

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