To the Board of Directors:
Applicant hereby submits the application for Membership to the Illinois Manufactured Housing Association. Applicant agrees to serve as a responsible member in good standing in the Association, and agrees to pay all dues in advance.

1. Application is hereby made on behalf of:

(Name of Applicant Company)

2. The applicant is (check one box):
    Sole Proprietorship
    Partnership
    Individual
      (does not fit into any other category as a Member).
    Corporation (LLC, LLP, etc.)
      (If a Corporation, the Corporation is organized under the laws of the State of ).

Business Address
City		State	IL AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
County	Select a county in IL Adams Alexander Bond Boone Brown Bureau Calhoun Carroll Cass Champaign Christian Clark Clay Clinton Coles Cook Crawford Cumberland Dekalb De Witt Douglas Dupage Edgar Edwards Effingham Fayette Ford Franklin Fulton Gallatin Greene Grundy Hamilton Hancock Hardin Henderson Henry Iroquois Jackson Jasper Jefferson Jersey Jo Daviess Johnson Kane Kankakee Kendall Knox Lake La Salle Lawrence Lee Livingston Logan McDonogh McHenry Mclean Macon Macoupin Madison Marion Marshall Mason Massac Menard Mercer Monroe Montgomery Morgan Moultrie Ogle Peoria Perry Piatt Pike Pope Pulaski Putnam Randolph Richland Rock Island St. Clair Saline Sangamon Schuyler Scott Shelby Stark Stephenson Tazewell Union Vermilion Wabash Warren Washington Wayne White Whiteside Will Williamson Winnebago Woodford Not in IL in IL	Zip
Mailing Address	(if different from business address)
	City    State  IL AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY    Zip
Phone		Fax
Email	IMHA will not give out, sell or otherwise transfer the e-mail addresses maintained by this website.
Requested Username		Password
Sponsored By		Date
*An active member of IMHA must sponsor each applicant
3. If the Applicant is a manufactured housing community, please indicate the number of sites (for each individual community): sites - This is a Senior Community: Yes No
4. The Delegate on behalf of the applicant is: (Insert here the name of the person IMHA should contact and who will have voting responsibility for Applicant at IMHA Membership meetings)
The relationship of the Delegate to the applicant is:
5. I am a (please check the membership category that best describes the applicant): Manufactured Home Community: Manufactured Housing Retailer Manufactured Housing Developer Home Manufacturer Financial Institution/Insurance Company Manufactured Housing Part Supplier Listing Firm Installer, Service Firm or Transporter Associate This is a non-voting membership category. Check this box only if you do not fit into any other membership category.