WICA Dues Form/Membership Renewal Form Name* First Last Company* Email* Phone*Which Membership Dues Are You Renewing?*Choose OneAssociate Member DuesAffiliate Member DuesTotal $0.00 Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name Δ