Unico Wla Membership_application90308[1]

UNICO National THE LARGEST ITALIAN-AMERICAN SERVICE ORGANIZATION IN THE UNITED STATES FAIRFIELD COMMONS • 271 U.S. HWY 46 WEST • SUITE A-108 • FAIRFIELD, NJ 07004 (973) 808-0035 • FAX: (973) 808-0043 • EMAIL: [email protected]

UNICO West Los Angeles direct email: [email protected]

MEMBERSHIP APPLICATION (Please print or type only)

Date Submitted_________________________ Date Approved _________________________

“Service Above Self”

_____________________________________ Signed by Chapter Secretary $___________ Initial Fee Attached

____________UNICO

Regular $100.00 Charter National Associate Honorary Life Youth Membership 18 to 25 Years Old “No Initiation Fee”

West Los Angeles____________ CHAPTER of UNICO NATIONAL

Applicant’s Name ______________________________________________________ Age ___________________ Home Address________________________________________________________________________________ City__________________________ State_________

Zip___________ Phone___________________________

Fax__________________ Mobile__________________ Email _________________________________________ Firm Name ___________________________________ Type of Business/Profession_______________________ Business Address_____________________________________________________________________________ City__________________________ State_________

Zip___________ Phone___________________________

Position Held_________________________________________________________________________________ Date of Birth _________________________ Place of Birth_____________________________________________ Are you an American citizen? ___ Yes ___ No

If foreign born, date naturalized __________________________

Spouse’s name (maiden) ____________ Date of marriage_________ Mother’s maiden name_________________ How long have you lived in our community? ________________________________________________________ List Involvement in Community/Organizations – Offices Held, if Any – Year ___________________________________________

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REFERENCES (Please list 2) Name________________________________________ Name_________________________________________ Address______________________________________ Address________________________________________ City__________________ Phone_________________ City__________________ Phone___________________ SPONSORS ____________________________________________

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Do you understand that UNICO NATIONAL is a Service Club of Americans of Italian Heritage dedicated to “Service Above Self?”

Yes Please mail application and check to: Unico West Los Angeles C/O Dave Donnini P.O. Box 521 Hermosa Beach, CA 90254

No

I hereby apply for membership and agree to abide by the Constitution and By-Laws of UNICO NATIONAL and this Chapter _____________________________________________________ Applicant’s Signature