LA SOCIETÁ ITALIANA, INC. NEW MEMBER FORM

    (ALL FIELDS WITH AN ASTERISK ARE REQUIRED)

    NEW MEMBER (#1) INFORMATION

    SPOUSE/SIGNIFICANT OTHER (#2) INFORMATION IF JOINT MEMBERSHIP

    CONTACT INFORMATION

    CHILDREN (IF APPLICABLE)

    *HOW DID YOU HEAR ABOUT THE CLUB?

    PLEASE DESCRIBE YOUR EXPECTATIONS FOR THE CLUB

    PLEASE SELECT (X) ANY OF THESE CLUB EVENTS/COMMITTEES TO INDICATE YOUR INTERESTS

    Committee
    #1
    #2
    Membership

    Checkbox_7


    Checkbox_1
    Publicity

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    Checkbox_2
    Cultural/Heritage

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    Checkbox_3
    Recipe

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    Web Site

    Checkbox_11


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    Event
    #1
    #2
    La Befana

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    Columbus Day

    Checkbox_13


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    Carnevale

    Checkbox_14


    Checkbox_19
    San Giuseppe

    Checkbox_15


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    Board Position (in the future)

    Checkbox_16


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    Event
    #1
    #2
    Annual Picnic

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    Italian Cooking

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    Carnevale Raffle

    Checkbox_24


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    Event Photos

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    Checkbox_30
    Bocce Ball

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    DUES CALCULATION AND MAILING INSTRUCTION

    1) Annual dues for the Fiscal Year are $60 per person or $120 per couple which includes children who live at home

    2) If you join after February 28th please reduce the above Dues amount by 50%, as the Club's Fiscal Year runs from September 1st through August 31st

    3) Make your check payable to “La Societa Italiana, Inc.”

    Please Mail your check to Maureen Colletta, 60 Lakeshore Drive, Berkeley Lake, GA 30096

    SIGNATURES (Use Mouse to Sign)