ICIMA Membership Request
​​Illinois County Information Technology Directors and senior staff from Information Technology Department (non-elected offices) are welcome to participate in ICIMA. ​There are no membership fees. Simply complete the form below for membership consideration.
Email address *
County *
Your answer
Department
Your answer
First Name *
Your answer
Last Name *
Your answer
Title *
Your answer
Office Phone Number *
Your answer
Cell Phone Number
Your answer
Mailing Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
County Web Site *
Your answer
Areas of Interest (check all that apply) *
Required
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google.