Today's Date *
Address: City *
State *	Zip *
Years in Area

Please identify and describe yourself:

Check one *	Mr. Mrs. Ms.
First Name *
Last Name *
Date of Birth *
Occupation/Retired *
Sex *	Male Female

Please identify and describe spouse/significant other when applying as a couple:

First Name
Last Name
Date of Birth
Sex	Male Female

Please provide the following contact information for the club directory:

Work Phone
Home Phone*
Mobile 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/Significant Other'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

Italian Food Making
Columbus Day
Annual Picnic
Web Site Committee
La Befana
Carnevale Raffle for Charity
Club Event Photography
Festa di San Giuseppe
Recipe Committee
Cultural/Heritage Committee
Bocce
Other - Please Describe:

Please note that initiation fee is a $50 per person ($100 per couple) one time fee and annual dues is $60 per person ($120 per couple) pro rated from September 1st which is the beginning of our fiscal year.

Please note that the Initiation Fee must be sent in along with this application for processing to begin.

Because this is an on-line application you can send the Initiation Fee to La Società Italiana, Inc. 1355 Northcliff Trace, Roswell, GA 30076.  At a later date you will be billed for the pro-rated remaining dues for the current fiscal year.

Thanks again for your interest in our Italian American Club.  Before 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 * below to signify that you have signed this application verifying that I/We wish to apply for membership in La Società Italiana, Inc. My/Our initiation fee has been sent in separately if this application since this is being entered on-line.  I/We will be billed separately for the pro-rated annual dues.

Applicant: 

Spouse/Significant Other (if joint application):