IACC Membership Application

Membership Application

To apply for membership please complete all the questions below.
Primary Member Information
Membership Type*
What type of membership are you applying for.
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Email*
example@example.com
Phone Number*
Please add a primary phone number
Phone Type*
What kind of a phone line is it?
Secondary Member Information
Name

First NameLast Name
Date of Birth

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Phone Type
What kind of phone line is it?
Dependent Children Information

Dependent children are children under the age of 21 years old.
Name

First NameLast Name
Date of Birth

MonthDayYear
Name

First NameLast Name
Date of Birth

MonthDayYear
Name

First NameLast Name
Date of Birth

MonthDayYear
Name

First NameLast Name
Date of Birth

MonthDayYear
How would you like to receive your monthly newsletter?*
Printed versions will only be sent to primary members.
Terms & Conditions

General

The IACC reserves the right to adjust membership dues and benefits at their discretion. All members will receive a 30-day notice prior to any such change. Membership can and will be terminated at any time for non-payment of dues and membership code of conduct violations.

Liability Release

I hereby assume full responsibility for all damages, injuries, or losses that I, any member of my household, or my guests may sustain or incur while on or near the IACC or the IACC Foundation premises. I hereby waive all claims or damages that I, any member of my household, or my guests may sustain.

Photo Release

I hereby grant the Italian American Community Center, the Italian American Community Center Foundation, their officers and employees the right to take photographs and video of myself, members of my household, and my guest, along with our perspective property in connection with the IACC and The IACC Foundation. I agree that the IACC & the IACC Foundation may use photographs and video for any lawful purpose including, but not limited to, publicity, illustrations, advertising and promotion.
Signature*

Clear
Signature Date
What to expect next?

After your submit your application below. Someone from the membership office will contact you to arrange for payment. Memberships terms run from January to December of each year. If your initial registration is made after March 31st a prorated amount will be charged until the next billing cycle.

If you have questions about your IACC membership application email us or call the office at 518-456-4222.
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Membership Application

Primary Member Information

Secondary Member Information

Dependent Children Information