2019 IGA Associate Member Registration
Thank you for supporting the Iowa Gaming Association in 2019! Please fill out this form to complete your Associate Membership registration. Payment will need to be sent as a check to Wes Ehrecke:

Iowa Gaming Association
C/O Wes Ehrecke
4401 Westown Parkway, Suite 209
West Des Moines, Iowa 50266

Questions can be sent to Wes at wese@iowagaming.org.

Company Name *
Your answer
Contact Name *
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Address (Street Address; City, State, Zip) *
Your answer
Phone Number *
Your answer
Fax Number
Your answer
Email *
Your answer
Company Website (N/A if none) *
Your answer
Social Media Websites (will be shown on our Member directory, alongside your website - for Gold, Diamond & Platinum levels)
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Link to Facebook, YouTube or Vimeo video you want embedded on the Member directory (for Diamond & Platinum levels)
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We committ to being an IGA Associate Member in 2019 at the following level: *
To pay my membership, I will: *
Please provide a brief description of your organization in 50 words or fewer for the IGA to include on its website. *
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