MEMBERSHIP APPLICATION

                                                                                                                                                                (Club Use Only)

 

MAIL APPLICATION TO:

The West Side Irish-American Club                                                                                                   #

8559 Jennings Road

Olmsted Township, Ohio   44138                                                                                                       #

Membership Dues:

(Jan 1st – Dec 31st)

$20.00 Per Person

(18 yrs & older)
 
(440) 235-5868                                                                                                                                                                                                                                                                                                                                  

                                                □ New                       □ Single                     □ Forever Young  (50YR & OLDER)

                                                                                                                                                             ($10 PER PERSON ADDITIONAL)

                                                            □ Renewal                 □ Family/Couple

 

Mr&Mrs                      Mr                   Mrs                  Ms                   Other                    (Specify)

 


Name                                                                                                   Date of Birth

 


Address                                                                                               Apt #

 


City                                                     State                                        Zip Code

 

Home Phone  (        )                                                                           Business Phone  (       )

 

                                                                                    E-Mail

 


Spouse Information (If Applicable)

 

Name                                                                                                   Date of Birth

 

E-Mail                                                                                                 Business Phone  (       )                                                                                   

Information for Children Under Age 18

 

Name                                       DOB                                        Name                                       DOB

 

Name                                       DOB                                        Name                                       DOB

 

Name                                       DOB                                        Name                                       DOB

 

Name                                       DOB                                        Name                                       DOB

 

Name                                       DOB                                        Name                                       DOB

 

Please check those committees on which you wish to participate

 

□Bartending               □Clam Bake               □Fish Fry                   □Steak Roast              □Pig Roast

□Ad Book                  □Bulletin                    □Cleaning Team        □Library                    □Public Relations

□Maintenance            □Other (                                           )