IACA

Indian American Catholic Association

Membership Registration Form

 

First Name:         Middle         Last

Address:              City:

 

State/Province:   ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon   Zip/Postal Code:    
Country: USA CANADA

 

Telephone (H):     (Cell):     email: 

 

Number of members in Family:  

 

Please check the community group(s) to which you are associated with:

Anglo-Indian  Bengali    Goan    Keralite  Mangalorean   Tamil

 

Pakistani  Sri Lankan  Bangladeshi Other

 

 

IACA Registration Fees

 

The annual IACA membership fee is $10.00 for families and $5.00 for individuals. Please make your check payable to IACA, Washington, DC, and mail it along with this membership form to:

 

IACA, c/o Sumathi Croos

Chairperson, Membership Committee

13905 Briarwick Street

Germantown, MD 20874-6239

 

You may also pay online via PayPal.

Note: You do not need a PayPal account to make an online donation to IACA.

 

If you have further questions regarding IACA membership, please send an email to IACA Membership.