Illinois Blockchain Association - Membership Application
This application is to apply for membership as an individual or organization in the Illinois Blockchain Association. The Illinois Blockchain Association is a non-profit organization that is focused on advocating for, organizing on behalf of, and educating about, the blockchain industry in the State of Illinois.

As of 2024, membership in the Illinois Blockchain Association is free; however, that may change in the future. 

If you are interested in donating to the Illinois Blockchain Association, please contact the Executive Director, Nelson Rosario, at the following email: n.rosario@illinoisblockchain.org. 

For any other questions, please email: info@illinoisblockchain.org.
Sign in to Google to save your progress. Learn more
Membership Type *
Name *
First and last name
Organization Name (if applicable)
Email *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Illinois Blockchain Association.

Does this form look suspicious? Report

Google Forms