Membership Application Form (Complete BOTH sides - all in block letters please)
- Title: First Name(s):
- Surname:______________________________________
- Address:
________________________________________________________________
- Occupation/Profession:
- Marital Status:
- Date of Birth:
- Country of Birth:
- Home Telephone:
- Cell:
- Email:
- Sponsor(s) Proposed by member (Name):
***All applicants must be sponsored by a member in good standing and be Irish-born,
of Irish descent or married to a member in good standing. ***
Please give us a brief account of your Irish background:
Other relevant information:
How did you come to hear of the Irish American Coastal Club?
What are your main interests?
To which other clubs or associations (e.g. alumni associations), if any, do you belong?
What specific activities would you hope to access in the Irish American Coastal Club?
*** The Annual Dues for the Club will be as follows:
$50 per individual $75 per household (includes all children under age 18)
Please make check payable to IRISH AMERICAN COASTAL CLUB
If elected to Irish American Coastal Club membership I undertake to observe fully its Rules and Regulations.
Signed………………………………………........................….Date………………………………..