MEMBER APPLICATION >
MEMBER APPLICATION - fill out the form below to apply online, or click here to download a form to apply by fax or mail.
Title of Contact 1:
Email Address of Contact 1:
Title of Contact 2:
Email Address of Contact 2:
Business Address 1:
Business Address 2:
ZIP - Postal Code:
(These are keywords separated by commasthat the public can enter to search for your company on LIFT's website.)
ie. Web, Hosting, Internet, Electronics
Credit Card Number:
3 Digit CCV number:
(The CVV# (Card Verification Value) is the
last 3 or 4 digits of the number on (or around)
the signature area on the back of your card.)
(Here you can place text that describes
your company and what it has to offer.
Please separate paragraphs with
double line returns.)
Select a member category for your enrollment.
This is a secure transaction.