ICBND - North Dakota's Independent Community Banks

Associate Membership Application Form

Company Name:
*Contact Person:
Street Address:
Mailing Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Website:
Additional Information:

* The person named above becomes your organization’s representative. This individual will receive all ICBND communications, the monthly newsletter, and exhibit and convention registration information. In addition, this is the person listed in the ICBND Associate Membership Directory.

We will invoice you for payment of your membership fees.