ICC Alumni Association Membership Form
Annual alumni memberships extend from July 1 to June 30 of the following year. Available options include individual lifetime membership as well as joint membership for the applicant and their spouse at a discounted rate. Membership is not limited to individuals who attended or graduated from ICC/IJC. Friends and supporters may also join the ICC Alumni Association.
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First Name *
Middle Name *
Last Name *
If different from above, name enrolled as:
Address *
City *
State *
Zip Code *
Phone Number *
Phone Number Type *
Alternate Phone Number
Phone Number Type
Alternate Phone Number 
Phone Number Type
Email Address (non-ICC email address) *
County of Residence *
Last Four Digits of Social Security Number *
Date of Birth *
MM
/
DD
/
YYYY
Reason for Joining the ICC Alumni Association *
Required
Dates of Attendance/Service at ICC
Activities/Honors at ICC
Current Occupation *
Level of Interest *
Required
Membership Information *
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