Membership-Sign-up-Form by asafwewe

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Membership-Sign-up-Form

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									                                Membership Sign-up Form

PLEASE COMPLETE

Individual memberships are offered for a suggested $50 annual contribution. Members
receive the Institute’s newsletter and have access to all events at the Institute. Please
complete this form and mail to: Membership, Italian Cultural Institute, 500 N. Michigan
Avenue #1450, Chicago, IL 60611. Please make checks or money orders payable to:
Italian Cultural Institute.

(MS./ MRS./MR. or Title)
First Name: ______________________________________________________
Last Name: ______________________________________________________

ADDRESS: ��Home ��Office (please specify)

Institution:________________________________________________________

Street___________________________________________________________

City _____________________________________ State ________ ZIP_______

Tel. (______) ______________________
Fax. (______) ______________________
E-mail: ___________________________________________
Profession: ________________________________________

To guide us in targeting the correct audience for our events, please complete the
following:
Are you interested in attending events presented in Italian:
��Yes �� No
Check no more than three subjects you are most interested in:
��Language/Literature
��Visual arts
��Architecture/Design
��Music and Dance
��Science /Technology
��Social Studies
��Cinema/Theatre
��Fashion/Cuisine

For detailed information about the Institute please visit our web site at
http://www.iicchicago.esteri.it

								
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