Membership Form

Application for Membership

Harp and Shamrock Society of Texas
Your Name *

First Name Last Name
Spouse Name

First Name Last Name
Home Phone # (Landline)
Your Mobile Phone #
Spouse Mobile Phone #
May we send texts to your number?

Yes, please! No, thanks.
May we text your spouse's number?

Yes, please! No, thanks.
Your email *
example@example.com
Spouse email
example@example.com
May we include your email address in our member directory?

Yes, please! No, thanks.
May we include your spouse's email address in our member directory?

Yes, please! No, thanks.
Names of Child(ren) and their age(s)
Please separate each child with a comma (,)
Home Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Please briefly describe your Irish background, if known. *
Your Irish Background (please type n/a if not known)
Type of Membership *
prev next ( X )
Individual Annual Membership
$ 20.00

Family Annual Membership
$ 35.00

Benefactor Annual Membership
$ 200.00

Patron Annual Membership
$ 500.00

Lifetime Membership
$ 1,000.00

Total

$ 0.00
Should be Empty:

Application for Membership