Membership Application Form

Please print and complete this form and send along with your check made payable to:	$25.00/family and $15.00/single membership ... and are due when you join the Club.
IACS, P.O. Box 530142 Debary, FL 32753

Become a Leprechaun Booster
You can support our newsletter by becoming a Leprechaun Booster. Contributions of $10.00 are due for 2006. If you are not a booster, please give the IACS a little extra support. The booster money is a big help in paying for the Leprechaun newsletter expenses. These can be paid to our Treasurer at any meeting or sent to the club as mentioned above.

Type of Membership: Please Check One
Family $25 Individual $15

Add'l Leprechaun Booster Support
$10

Total Amount Inclosed:

Name

Phone

Email:

Complete Address w/City, State, Zip

Ancestral Irish County: (if known)

Interests and Hobbies:

Family Information (Spouse, children, etc.):

Please check any of the following committees that interest you. Please note, openings may not be available.

Meeting Refreshments	Newsletter	Membership	Parade
Cultural Events	Christmas Party	Heritage	Website

Comments or Questions?