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EMERALD ASSOCIATION APPLICATION FOR MEMBERSHIP

I hereby apply for membership in the Emerald Association of Putnam County, State of New York, and make each of the following statements of fact, personally known to me, intending that the Association rely upon the truth of each in acting upon this application.

Member Information:

 

Name(s):                                                                                                                                         

Street Address:                                                                                                                                

City:                                                                             State:                         Zip Code:                    

Phone Number:                                        Fax Number:                                                                     

E-Mail Address:                                                                                                                                

Names & Ages of Children:                                                                                                               

Brief History of Irish Ancestry:                                                                                                           

                                                                                                                                                         

Preferred method of  communication from the Emerald AssociationqUS Mail q E-Mail

How did you learn about the Emerald Association?

q By Member

q Please enter name:

_______________________________

q Website

q A Feis

q News Release

q Another Organization

q Special Events

q Newsletter

q Other

________________________

 

Please Indicate the Committee(s) You Are Willing to Serve On (check all that apply):

q Membership

q Programs

q Publicity

q New Member Orientation

q Community Relations

q Welfare

q Website

q Scholarship

q Newsletter

q Special Events

q Feis

q Board of Directors

q Parade

q Dance

q Other

If elected to membership, I agree to abide by and be governed by the Constitution and By-Laws

 of the Emerald Association and any future amendments, modifications, and changes thereto.

 

 

     Signature:                                                                                                         Date:                           

                                 Annual Dues  - January through December  (please indicate category): 

                q  Family - $25  q  Single - $15       

Return Application: The Emerald Association of Putnam County, P.O.Box 141, Brewster, NY 10509;

or to Membership Secretary, Rose Kelly, 502 Seven Fields Lane, Reed Farm, Brewster, NY 10509

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  © 2006 Emerald Association of Putman County