Membership Application Name:____________________ Address: _________________ City: ____________ State____ Zip_______ E-mail:_____________Home Telephone:__________________ Work Telephone: _________________ Birth Date: ___________ Occupation:______________________ Favorite Italian restaurant in the Bronx & Westchester: _______________ What region of Italy did your family emigrate from:_____________(or) What is your favorite region of Italy__________________________ What type of events would you be most interested in attending?_________ Would you be interested in helping to plan events____________________ How Did you hear about us?   __Friend   ___Website   __FIERI                                                                                International _______________________________     __________________ Signature                              Date