ITALIAN COMMUNITY OF AKRON INC. “LE RADICI”
MEMBERSHIP APPLICATION TODAY'S DATE:_________
The Italian Community of Akron (Ohio) Inc. wants to reach the entire Italian-American
community and all of those who love Italy. The main objective of our association is to organize and promote
activities with the purpose of introducing to the Italian community the different facets of the Italian culture.
Dues for the year are: Family $50.00 and includes children ages 18 and under. Individual ‐‐$30.00 Seniors – 65 & over ‐$20.00
There are no membership dues for full time students ages 18 – 23. Dues are payable at time of acceptance into organization.
NAME_________________________________________ SPOUSE (if also joining) ________________________________________
ADDRESS__________________________________________ CITY______________________STATE_______ ZIP_______________
PHONE______________________E‐MAIL ADDRESS___________________________________
ACTIVE OR RETIRED OCCUPATION FOR APPLICANT___________________________FOR SPOUSE_____________________________
BIRTH DATE ‐ APPLICANT______________ SPOUSE ______________ ITALIAN DESCENT Y / N REGION________________________
NAMES AND BIRTHDATES OF CHILDREN LIVING AT HOME AGES 18 AND UNDER AND FULL TIME STUDENTS AGES 18 – 23.
1)_________________________________BD_______________ 2) ________________________________BD_______________
3)_________________________________BD_______________ 4) ________________________________BD_______________
5)_________________________________BD_______________ 6) ________________________________BD_______________
NAME OF “LE RADICI” MEMBER (s) SPONSORING YOU _______________________________________________________________
1. How did you find out about “Le Radici”?
_______________________________________________________________________2. Why are you interested in joining?
_______________________________________________________________________________________________________________________________________________________________________________________
3. Are you willing to support club activities?
YES / NO 4. Will you attend meetings on a regular basis? YES / NO5. Will you assist in and partake in club events?
YES / NO 6. Comments: _________________________________________________________________________________________________________________________________________________________
Send your application to:
Le Radici attn: Membership Chairperson P.O. Box 258 Tallmadge, OH 44278You will be notified of your acceptance and sworn in at the next membership meeting. Dues should be paid at that time.
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*FOR OFFICE USE ONLY
Date application received_____________ By___________________________
Date of Board recommendation of membership acceptance ______________
Date of installation and membership dues paid ________
Amount $ ___________All above dates verified by Membership Chairperson _________________________________ Date_____________________
(form revised 3/28/10 by JMM)