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Membership Application

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Carefully review the information which you have entered. If correct, print this page. If not, close this window and make your corrections.

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Membership Qualification

") sendWin.document.write("Were you born in Cefalù?") sendWin.document.write(" " + choice1) sendWin.document.write("
") sendWin.document.write("If not, name of ancestor:") sendWin.document.write(" " + choice2) sendWin.document.write("
") sendWin.document.write("Relationship:") sendWin.document.write(" " + choice3) sendWin.document.write("
") sendWin.document.write("If not, name of spouse:") sendWin.document.write(" " + choice4) sendWin.document.write("
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Your Name

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") sendWin.document.write("First name:") sendWin.document.write(" " + choice6) sendWin.document.write("
") sendWin.document.write("Middle or maiden name:") sendWin.document.write(" " + choice7) sendWin.document.write("
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Your Address

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") sendWin.document.write("Apartment #:") sendWin.document.write(" " + choice9) sendWin.document.write("
") sendWin.document.write("City:") sendWin.document.write(" " + choice10) sendWin.document.write("
") sendWin.document.write("State/Province:") sendWin.document.write(" " + choice11) sendWin.document.write("
") sendWin.document.write("Zip/Postal Code:") sendWin.document.write(" " + choice12) sendWin.document.write("
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Your Phone, Fax, E-mail

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") sendWin.document.write("Fax number:") sendWin.document.write(" " + choice16) sendWin.document.write("-") sendWin.document.write(choice17) sendWin.document.write("-") sendWin.document.write(choice18) sendWin.document.write("
") sendWin.document.write("E-mail address:") sendWin.document.write(" " + choice19) sendWin.document.write("
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Carefully review the information which you have entered. If correct, print this page. If not, close this window and make your corrections.

") sendWin.document.write("Mail with your check or money order for $40.00, payable to 'Cefalutana Society':
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Società Italiana Di Mutual Beneficenza Cefalutana
") sendWin.document.write("4226 Orleans Avenue
") sendWin.document.write("New Orleans, LA 70119-4606
") sendWin.document.close(); } } // end hiding from older browsers -->

SOCIETÀ ITALIANA
Di Mutua Beneficenza Cefalutana

Membership Application

Fill in the form below to generate your membership application online.

Step 1. Fill in all required fields, then click the submit button at the bottom of this page.
Step 2. Review and verify the information in your application
Step 3. Print the application, and mail with your membership fee and dues.

Were you born in Cefalù? Yes No

If not, name of ancestor:
Relationship:
If not, name of spouse:

Your Name

Last name:
First name:
Middle or Maiden name:

Your Address

Street address (or rural route and box no.):
*Apt #:
City:
State/Province:
Zip/Postal Code:

Note: For outside the U.S. and Canada, please modify after printing.

Phone/Fax/E-mail

Phone number: --
*Fax number: --
*E-mail address:


*Not required



Clicking submit will generate a membership application including the above information for your review before printing.

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