Affiliate Organization Membership

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Affiliate Organization Form

Please fill out the following information to submit an Affiliate Organization Membership with the Joint Civic Committee of Italian Americans.

Name of Organization

Organization Mailing Address

Street Address, City, State, ZIP

Please major President

Which Affiliate Organization Membership will you be purchasing?

$100 (for organizations with 1-49 members)
$250 (for organizations with 50-99 members)
$500 (for organizations with 100+ members)

Organization's President

President Mailing Address

Street Address, City, State, ZIP

President Email

President Phone Number

Delegate

Registered delegates are authorized to represent your organization and participate in elections or votes when the president is unable to.

Delegate Mailing Address

Street Address, City, State, ZIP

Delegate Email

Delegate Phone Number

Secondary Delegate

Registered delegates are authorized to represent your organization and participate in elections or votes when the president is unable to.

Secondary Delegate Mailing Address

Street Address, City, State, ZIP

Secondary Delegate Email

Secondary Delegate Phone Number

Please include any regular meeting information or major event dates for you organization below:

Credit Card

Click Here to Download the Affiliate Organization Form

Become and Affiliate Organization of the Joint Civic Committee of Italian Americans!

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