Download - The Italian Club of Tampa

NOVEMBER/DECEMBER 2004YES, I WANT TO BE A MEMBER OF THE ITALIAN CLUBMEMBERHSIP TYPE (ANNUALLY):Student ($25)_______ Senior, 65 yrs + ($55)_______ Individual ($100)_______ Family ($150)_______CONTRIBUTORY (TAX-DEDUCTABLE)*Patrons ($200)_________ Benefactor ($300)_________ DaVinci ($500)_________NAME__________________________________________ DATE OF BIRTH________________ADDRESS____________________________________________________________________CITY__________________________STATE__________________ZIP CODE________________EMAIL______________________________________________________________________PHONE #____________________________SPOUSE________________________ MALE:_____ FEMALE:_____ DATE OF BIRTH:__________CHILD_________________________ MALE:_____ FEMALE:_____ DATE OF BIRTH:__________CHILD_________________________ MALE:_____ FEMALE:_____ DATE OF BIRTH:__________CHILD_________________________ MALE:_____ FEMALE:_____ DATE OF BIRTH:__________I would like to assist in the following areas:Accounting ___ Building ___ Cemetery ___ Cultural ___Festa Italiana ___ Food Prep ___ Fundraising ___ Gasparilla ___Governance ___ Grants ___ Guavaween ___ Insurance ___Ladies Auxiliary ___ Maintanence ___ Membership ___ New Year’s Eve ___Newsletter ___ Photography ___ Picnic with the Past ___Smoker Night ___ Social ___ Website ___ Volunteer ___Please send this application and a check or money order payable to:The Italian Club of Tampa, Inc.Post Office Box 5054Tampa, Florida 33675*Contributory Members should make checks payable to ICBCTF (The Italian Club Building & Cultural Trust Fund)PAGE 20