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 Association (check one):    q  US Mail    q   E-Mail

                  How did you learn about the Emerald Association?

     q  Referred by a Current Member (member’s 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  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 - $20    q  Single - $15              q  Senior Citizen - $10     

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