Welcome to LICA's online event registration page. Please use this form to register attendance and/or to take a sponsorship for upcoming LICA events. Credit card payment for sponsorship or non-member registration fees (if applicable) can be made online after you submit this form. If you prefer to pay by check instead, please state that in the Notes field at the end of the form, then make your check payable to LICA and mail to: LICA, 48 S. Service Road, Suite 401, Melville, NY 11747.

For more information about each event, please click here. We look forward to seeing you soon.

Event Name:
Please Select One... Holiday Party LICA Safety Seminar (Jan 13)

Company Information:

Company Name:


Membership Status:
Please Select A Status LICA Member/Partner (FREE) Elected Official/VIP Invite (FREE) Non-LICA Member $60 (Holiday Party) Non-LICA Member $50 (Safety Seminar)

Contact Person:


Contact Phone:
() -

Contact E-mail Address:


Number Of Attendees: (Please list Attendee Names Below)

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Attendee Information:

Attendee #1:	Attendee #6:
Attendee #2:	Attendee #7:
Attendee #3:	Attendee #8:
Attendee #4:	Attendee #9:
Attendee #5:	Attendee #10:

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BE A LICA EVENT SPONSOR (Optional)

--Choose an Option-- Bridge Sponsor ($1,000) Highway Sponsor ($500)

Contact Sheryl Buro at: to provide ad or logo artwork.

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By clicking the "Submit" button below, your registration information will be sent to LICA. Please review all information above before you continue.

Please check the "I'm not a robot" box below to submit this form