LICS Membership Form

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Upon completion of this form, mail your check (made payable to Lancaster Italian Cultural Society) to Lancaster Italian Cultural Society, Attn: Peter H. Byrne, P.O. Box 36, Smoketown, PA 17576

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Date

YYYY

Last Name

First Name

Birthdate

Spouse/Partner Name

Spouse/Partner Birthdate

Street Address

City

State

Zip Code

Those living in the same household at the same address are included in your LICS membership. Others (names, and ages if under 21 years) in this household at this same address.

Home and Cell Telephone numbers. Indicate primary telephone number.

Email addresses (By providing your email addresses you agree to receive email correspondence from LICS, including but not limited to, Constant Contact eBlasts and the LICS Board of Directors.)

Please indicate your committee(s) interest

Annual Spaghetti Dinner

Cultural/Education

Events/Programs

Hospitality

Public Relations

Newsletter

Awards/Education Grants

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How did you hear about LICS and what influenced you to join? Detailed answers are appreciated.

New Member Dues (Membership fee for new members is based on when this application is submitted.)

$45: When joining January through June, membership is active through to the end of the year.

$22.50: When joining July through October, membership is active through to the end of the year:

$67.50: When joining July through October, membership is active through to the end of the next year.

$45: When joining November or December, membership is active through to the end of the next year.

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A copy of your responses will be emailed to the address you provided.

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