Application

Personal Information (for internal use only)

Name:______________________________
Address:_____________________________
City:_____________ State:_____ Zip:_____
Phone:____________ Cell:______________
Email:_______________________________

Business Information(for website and business promotion)

Business Category:_____________________
Business Name:_______________________
Representative Name:__________________
Title:________________________________
Address:_____________________________
City:____________ State:____ Zip:_______
Phone:___________ Fax:_______________
Email:_______________________________
Website:_____________________________
Brief description of your business and
services provided______________________
____________________________________
____________________________________
____________________________________
____________________________________
____________________________________
__________________________________

I found the Toulon Civic Association
through
□ Internet
□ Facebook
□ Current Member____________________
□ Other________________________

Commitment

• I understand that the TCA has annual membership dues.
• I understand that I pay the dues according to the membership fee schedule and they are nonrefundable.
• I am willing to network with and support other members of the TCA.
• I am willing to invite guests to attend and possibly join TCA.

Information provided will be used in processing
your membership in the Toulon Civic Association.

Applicant Signature:_______________________
Date:________________________________________

□ Payment Included 
□ Invoice Me

Please mail your application and choice of
payment to:
Toulon Civic Association
PO Box 574
Toulon, Il.
61483