Irish Cultural Society
Membership Application Form

Name:____________________________________________________________ 

Home Address ____________________________________________________
	    Number and street	City		State    ZIP

Phone: (H)_______________(W)______________ Cell ____________________

E-mail Address: ___________________________________________________

• Applicant should have some interest in Irish Culture.
• Applicant does not need to be of Irish heritage or ancestry.

Special Interest(s): Music___, Dance___, Genealogy___, 
History___, Other ______________________________________________
                        Check all that apply. If "other" describe.

What Activities would you like to help with?
Social Events___, Programs___, Publicity___,Membership___,  Public Speaking___, 
News Letter ___,  Fund Raising_____, Other_______________________
                        Check all that apply. If "other" describe

Yearly Dues: Family Membership: $25.00, Single $25.00, Associate (Non-Voting) $5.00

This application form must accompany your check for annual dues.

Make Check Payable to: Irish Cultural Society
Mail to: Irish Cultural Society, 247 Patricia Dr.,San Antonio TX 78216

   PRINT THIS PAGE,  Fill it out,  and mail it in.