Membership Application IHC Membership Application Membership Enrollment APPLICATION Please indicate whether you are applying for a REGULAR or ASSOCIATE membership and complete both sides of this application. REGULAR MEMBERSHIP I am applying for regular membership. I am Italian, married/partnered to an Italian and the individual with Italian heritage is currently a member or joining with me. I am Italian I have an Italian spouse/partner ASSOCIATE MEMBERSHIP I am applying for an associate membership. I am not Italian, nor is my spouse/partner, if applicable. Name * Name First Name First Name Last Name Last Name Phone Email * Address Address Address Line 1 Address Line 1 Address Line 2 Address Line 2 City City State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zip Code Zip Code DATE OF BIRTH Occupation MARRIED/PARTNERED Yes No SPOUSE/PARTNER APPLYING Yes No SPOUSE/PARTNER NAME DATE OF BIRTH SPOUSE/PARTNER TEL # SPOUSE/PARTNER EMAIL SPOUSE/PARTNER OCCUPATION Have you ever been a member of the Italian Heritage Center? Yes No If yes, when? FEES AND DUES FOR MEMBERSHIP The Membership Secretary will notify you of the prorated dues amount. Your Signature signature keyboard Clear Sponsor’s Signature signature keyboard Clear Father’s name (if Italian) Mother’s name (if Italian) Please check where appropriate. Family born in Italy: Myself My parent(s) My grandparents OtherOther WHERE: Region – City/Town (Italy has 20 Regions and many provinces, cities and towns) Are you familiar with the Italian language? Yes No If yes, can you Read Write Speak the language? Why do you want to join the Italian Heritage Center (IHC)? YOUR INTERESTS Advertising Buildings & Grounds Charity Children’s Parties Christmas Fair Concert Band Cultural Italian Lessons La Cantina (lounge) Library Scholarship OtherOther After receiving your application, you will be contacted for an interview. If you are accepted into our membership, we will collect your prorated dues at that time. Thank you. Date Submitted Captcha Submit If you are human, leave this field blank.
