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Sign up for an ICE College - Single membership today!

Please fill in ALL of the information below. After you have filled in the online form, please click the "submit" button at the end of the form to submit your online registration information and then follow the steps to process payment for your new ICE Individual membership.

Instructions:
Fill out MEMBER 1 information as applies to the individual. List emergency contact information in preferred calling order. Click the "submit" button when complete.

Additional information about the program and the additional steps you should follow will be given to you after payment is processed for the new membership.

* = Required Fields

College/Organization Information
Name of College or Organization:

Member 1 Information
*Member Name:
Address:
City:
State:
Zip Code:
*Daytime Phone:
Evening Phone:
Dealership:
Salesperson:
Date:	Year:	Make:	Model:
Cell Phone:
*Email Address:
Blood Type:
Medical Allergies:
Medical Conditions:
Medical Information:
Donor? (Please put "yes" or "no):

Emergency Contact #1
Contact Name:
Address
City:	State:	Zip:
Daytime Phone:
Evening Phone:
Cell Phone:
Email Address:
Relationship:

Emergency Contact #2
Contact Name:
Address
City:	State:	Zip:
Daytime Phone:
Evening Phone:
Cell Phone:
Email Address:
Relationship:

Emergency Contact #3
Contact Name:
Address
City:	State:	Zip:
Daytime Phone:
Evening Phone:
Cell Phone:
Email Address:
Relationship:

Emergency Contact #4
Contact Name:
Address
City:	State:	Zip:
Daytime Phone:
Evening Phone:
Cell Phone:
Email Address:
Relationship:

Emergency contacts and medical information can be changed at any time with the customer's written request or by phone at 877-564-6423 (join ICE). I understand ICE USA, Inc. or (its assigns) is authorized to release any of the above contact information. ICE will only release medical information to proper authorities. ICE shall not be liable for failure to notify contacts in any instance where emergency service personnnel fails to notify ICE of an incident. ICE shall not be liable if notification to customer or other contacts are unsuccessful after reasonable attempts have been made utilizing all telephone numbers provided by the customer. ICE shall not be liable for medical information if customer fails to supply us with information or does not inform us of any and all changes to medical information. This membership is between ICE and the above members and any third party shall be held "hold harmless."

Please click submit to agree:
"I have read and understand what this service provides."

To purchase an ICE� Individual Membership please fill out the complete form to the left and click "submit" when finished. After your formed is submitted, you will be taken to the payment process page where you can then submit payment securely only for your new membership.

If you would like to purchase a service by check, please download an application form in pdf format below and send your filled out form and check made payable to ICE USA, Inc.

Download the ICE� application form here.

All prices quoted are for annual renewable policies.

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The products you receive with your new ICE� service:

The ICE� Alert Sticker
This is to be placed on the members' wireless phone. This can also be placed on the window next to the front door, or on the back of a members' portable music device.

The ICE� Vehicle Decals
These are issued in pairs. One can be placed on the bottom of the drivers' side front windshield of the members' vehicle. The other is to be placed on the same side of the rear windshield. This decal can also be placed on the inside of a motorist helmet, or on the frame of a bicycle.

The ICE� Member Identification Card
This card resembles that of a credit card and is to be placed behind the members' drivers' license.

The ICE� Key Fobs
These key fobs have several different places and purposes. They are also issued in pairs. Key Fobs can be placed on the members' key chain, on a jackets' zipper pull, or tied on a shoe lace.

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