Join Herricks Indo - US Community.

Join Herricks Indo-US Community.

Membership Type :

Life Membership $100
Annual Family $25
Guest $0

Benifits of Membership!

Login Information * Required

e-mail ID:*

Choose Password:*

Confirm Password:*

Personal Details * Required

Member First name:*

Last Name :*

Address * Required

House Number :*

Street Name :*

Town:*

State:*

Zip / Postal Code:*

Phone:*

- - eg : 123 - 123 - 1234

Resident:

Herricks Non Herricks

Occupation:

US Citizen:

Yes No

Regd. to Vote:

Yes No

Details of Spouse

Name of spouse:

Spouse e-mail:

Occupation:

US Citizen:

Yes No

Regd. to Vote:

Yes No

Other Adults in Household

US Citizen Yes No

Regd. Voter Yes No

US Citizen Yes No

Regd. Voter Yes No

Names of Children

Age

Grade

School Name

Total number of members per family:

Talents willing to share:

Will help in :

Membership	School / PTA
Cultural Programs	Fund Raising
Educational Programs	Hospitality / Food
Public Relations	Newsletter Writing
Computer / Website	Community Group Liason

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Please make all checks payable to:
HERRICKS INDO-US COMMUNITY,INC.
C/O Membership
38 KINGS LANE
NEW HYDE PARK , NY 11040