Application for Membership

Name: _______________________________________________________


Address: _____________________________________________________


City: _______________________ State: _______ Zip: _________________

Home Phone: __________________ Work Phone: ____________________


E-mail: ________________________ Fax #: _________________________


Occupation: ___________________________________________________

I hereby apply for membership, agreeing to support the Italian American Human Relations Foundation of Chicago and its' mission of abolishing ethnic and racial stereotyping, fostering harmony and mutual respect.


Signature _______________________________________________Date______/_______/_______


Fill out and mail with your check for $30.00 to:
The Italian American Human Relations Foundation of Chicago
624 N Western Ave
Chicago IL 60612

or call: 773-276-7800.

This is a not-for-profit organization.