Italian American Cultural Association Membership form

Italian American Cultural Association of Virginia, Inc.

Membership Application

Dues: Family $30 Individual $20

Call Maryann DeVincentis for current mailing address.
(804) 784-6124

*=Required field.

*Date
*Name:
Birth Month:
Birth Day:
*Address:
*City:
*State:
*Zip:
*Phone Number:
*E-mail Address:
If you or your spouse is Italian, please state area of Italy your family is from if known.

Please consider a contribution to one of our scholarship funds. Many corporations provide matching funds. You may also want to consider a special bequeath in your estate planning.
	Hilda Manieri Traina/IACA Scholarship Richard Bland College	$
	Fierro Family/IACA Scholarship Virginia Commonwealth University	$

PLEASE PRINT A COPY OF THIS FORM FOR YOUR RECORDS BEFORE SUBMITTING.