India Cultural Centre (ICC)
1595, NY STATE Route 26
Vestal, NY-13850
www.iccbinghamton.org
Annual Membership Form
ICC membership runs from January 1st to December 31st
**Basic Annual Membership: $40.00 per family
***Elite Annual Membership: $300.00 per family
Please attach the completed form to your membership check made to ICC and mail it to the address shown
above. Please include Attention: EC Treasurer in the address
Name (Last, First) ___________________________________________________________________
Spouse’s Name (Last, First) ___________________________________________________________
Home Address _____________________________________________________________________
Telephone_________________________________________________________________________
(Home)/Cell/Work/Business____________________________________________________________
Email
Address/es______________________________________________________________________
Check amount enclosed____________ Annual membership for the year: ____________________
** Basic membership provides a savings of about 5 to 6 dollars per ticket to ICC events such as Holi, &
Diwali
*** Elite membership is a convenient one time payment that covers non transferable tickets per family for
events such as Holi & Diwali and more.
!! Thank You for becoming a member of the organization!!
For Office Use Only
Check no._______________
Check Date: _______________________
Apply membership to year: __________________________________