Corporate Membership Request Form

Please enter your contact information below.

Organization Information

What organization do you belong to?

Start typing your organization's name in the field above. If your organization does not appear, be sure your spelling is correct or an alternate name isn't available. If your organization's name still does not appear, choose the "I am affiliated with an organization, but it does not appear" option below.

* - indicates a required field.

Type of Membership applying for

For information about LCI Corporate Subsidiary Memberships, please email

Organization Contact Information

Main Contact

Billing Contact

Please check preferred Phone (if more then one.)

Please check preferred Email (if more then one.)

Please check preferred Phone (if more then one.)

(If different from Personal contact information above)

Mailing Address

Billing Address

Create a Profile

Password must be a minimum of eight characters and contain at least one special character, one lowercase letter, one uppercase letter, and one number.

Communication Options

Note: if you select "Do Not Email" you will not receive any email blasts (ie: event updates, Congress emails, or newsletters), but you will still receive all personal communication emails.

Other Information

has an existing corporate membership. Go to MyLCI to create a member profile.