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Member Application

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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.

Step 1:

Member Info
Please add your company name.
Please add your company phone number.
Please add a valid email.
Physical Address
Please add your address.
Please add your country.
Please add your City.
Please add your State.
Please add your Postal Code.
Mailing Address
Please add your address.
Please add your country.
Please add your City.
Please add your State.
Please add your Postal Code.
Social Network Addresses

Step 2:

Additional Info
Please add your number of full-time employees.
Please add your number of part-time employees.
Looks good!

Step 3:

Primary Contact
Please add your first name.
Please add your last name.
Please add your phone number.
Please add a valid email.

Contact Preference

Address
Please add your address.
Please add your country.
Please add your City.
Please add your State.
Please add your Postal Code.

Step 4:

Billing Contact
Please add your first name.
Please add your last name.
Please add your phone number.
Please add a valid email.

Contact Preference

Address
Please add your address.
Please add your country.
Please add your City.
Please add your State.
Please add your Postal Code.

Step 5:

Please complete the Captcha

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