Founded 1737
Application for Membership
Name ________________________________________________________
Residence ________________________________________________________
Address ________________________________________________________
Phone ( ) __________ Fax ( )___________ e-mail _________________
Business _________________________________________________________
Address _________________________________________________________
Phone ( ) __________ Fax ( )___________ e-mail _________________
Preferred Mailing Address [ ] Residence [ ] Business
Occupation _____________________________________________
I hereby apply for membership in THE CHARITABLE IRISH SOCIETY
Applicant’s Signature _______________________________ Date ________
Sponsored by ____________________________________
Please forward this application with a check for $50.00 to
The Charitable Irish Society
5 Acorn Street
Boston, MA 02108