IACS Celtic Band
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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 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?