Rochester, NY 14606
When we receive this form from you we will send you the requested number of official applications by US Postal Mail. When joining, please send the official carbon application and payment to the address above. We will contact you with information about upcoming meetings and answer any questions.
If you have any questions, please contact:
Thomas Meleca, Membership Chair at 315-986-1097 or firstname.lastname@example.org
Applicant’s Name: _______________________________________________________
Applicant’s Mailing Address: _______________________________________________
Home Phone: ____________________________ Cell Phone: ____________________
Marital Status: ___________ Spouse’s Name: ________________________________
Are you of Italian lineage: Y__ N__ Number of Applications Requested: ____________
Do you belong to any other Italian American organizations: Y__ N__
We look forward to hearing from you!