Membership Application
Vermont Alliance of Independent Country Stores

Please fill out the following form and press the 'Submit VAICS Membership Application' button

If you wish, you may telephone your information to VAICS in care of the Vermont Grocers Association (802-775-5460) or print and mail/fax this form in PDF format. Send to Vermont Grocers Assosciation, 135 North Main Street, Suite 5, Rutland, Vermont 05701, or fax them to 802-773-2242.

This information will not be used for advertising or promotion, or given or sold to entities outside the Alliance or the VGA.

Store Name
Your Name
Number/Street/Box
Address Line 2
City/Town/Village
State
Zip/Postal Code
Telephone
Fax
Email
Website

Membership type:
Voting Member at $50
Associate Member at $100
Supporting Member at Higher Level

• New member retailers will be billed upon approval of the Alliance membership committee.
• Associate and supporting members should follow up this submission with a check.

We may take the opportunity to visit your store to approve your membership. Please provide a brief description of your store (age, ownership, stock, etc.) and directions to it:

Applications for retail voting membership in the Alliance must be approved by the membership committee to ensure criteria are met on the reverse side of this application. Membership in the Vermont Grocers' Association is also required for retail voting or associate members of the Alliance.

Return to VAICS Home Page without joining.