Date
Address: City
State	Zip
Years in Area

Please identify and describe yourself:

First Name
Last Name
Date of Birth
Occupation/Retired
Sex	Male Female

Please identify and describe your spouse if applying also:

First Name
Last Name
Date of Birth
Sex	Male Female

Please provide the following contact information for the club directory:

Work Phone
Home Phone
FAX
E-mail

Please identify and describe your children if applicable:

Name
Age
Sex	Male Female

Name
Age
Sex	Male Female

Name
Age
Sex	Male Female

Name
Age
Sex	Male Female

Name
Age
Sex	Male Female

Name
Age
Sex	Male Female

Ancestor's origin?

Spouse's ancestor's origin?

What are your expectations from the club?

Select any of the following committees/events you would be interested to help out with - check all that apply:

Membership Committee
Publicity Committee
Carnevale
La Befana
Columbus Day
Annual Picnic
Fest di San Giuseppe
Wine Tasting
Cultural/Heritage Committee
Bocce
Other

Please note that initiation fee is $50 per person and annual dues is $60 per person pro rated from September 1st which is the beginning of our fiscal year.

Thanks again for your interest in our Italian American Club.  After you click on the Submit Form please make a copy of your application for your records.  We will get back to you shortly...

Please type your name here to signify that you have signed this application: