Member Application

Apply

To start the process of becoming an LIA member, please fill out the application below.

After it is complete, you will receive a confirmation email, followed by instructions on how to manage your account and pay your invoice through the LIA Member Portal.

If you are interested in becoming a member and have not yet spoken to someone at the LIA or you have any questions, please reach out to Dave Fattizzo, Director of Membership, at dfattizzo@longislandassociation.org.

Please note when you are adding your website or social media accounts to the application please copy and paste the entire url from your social media pages. Thank you for your time.

Step 1: Member Info

Step 2: Additional Info

Step 3: Primary Contact

Step 4: Billing Contact

Step 5: Membership Options

Step 1:

Member Info

Company Name *

Please add your company name.

Phone *

Please add your company phone number.

Website *

Please add your company website.

Email *

Please add a valid email.

Physical Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Mailing Address

Same as physical address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Social Network Addresses

Facebook

Twitter

Instagram

Step 2:

Additional Info

Directory Category *

Please select a directory category.

Full-time Employees *

Please add your number of full-time employees.

Part-time Employees *

Please add your number of part-time employees.

Join A Committee

County: *

Looks good!

NYS MBE Certified

NYS WBE Certified

NYS SDVOB Certified

DBE Certified

Other Certification

My business is not certified, but has a majority MWBE or SDVOB ownership

Step 3:

Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone *

Please add your phone number.

Email *

Please add a valid email.

Contact Preference

Phone

Address

Same as Address in Step 1

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Step 4:

Billing Contact

Same as Primary Contact

First Name *

Please add your first name.

Last Name *

Please add your last name.

Title

Phone *

Please add your phone number.

Email *

Please add a valid email.

Contact Preference

Phone

Address

Address line 1 *

Please add your address.

Address line 2

Country *

Please add your country.

City *

Please add your City.

State *

Please add your State.

Postal Code *

Please add your Postal Code.

Step 5:

Comments/Questions

Please complete the Captcha

Back Next Submit Application Print Application

Member Application

Apply

Step 1:

Member Info

Physical Address

Mailing Address

Social Network Addresses

Step 2:

Additional Info

Step 3:

Primary Contact

Address

Step 4:

Billing Contact

Address

Step 5:

Get In Touch!

Additional Resources

Stay Connected!