*1.Name(Required.)

*2.Home Address(Required.)

*3.Phone Number Cell/Home(Required.)

*4.Email Address(Required.)

*5.Date of Birth(Required.)

*6.Occupation/Profession(Required.)

7.Spouse and Children's Names (Family Plan)

*8.Membership Type(Required.)

Individual Membership  $30.00

Senior Membership  $25.00

Family Membership (Couples and all Children Under 23 at Home)  $45.00

9.Name Badges (Optional)  $13.00 ea.

Pin Back

Magnetic Back

10.1. Committees You Would Be Interested In Serving On 
2. How did you hear about us?

1. Membership

1. Social Activities/Events

1. Cultural Presentations

1. Halfway To St Patrick's Day Family Picnic

1. St. Patrick's Day Parade

1. Annual Christmas Party

 2. Website

2. Celtic Festival

2. Info table at show

2. Friend

2. Other