International Center Registration Form

Membership Application

Apply

Please complete this e-mail form to become a member at the International Center and we will contact you to schedule a free orientation appointment (form must be completed in English).

When you come to the Center for your orientation appointment, please bring:
     -  2 small photos
     -   Identification
     -   Payment of membership fee in cash, check, or Visa/Mastercard/American Express.

NOTE: All fields in red are required for submission.
Prefix:



Apt:





Gender:
Date Of Birth:	19
Country of Birth:
Arrival Date in the US:
Occupation (Job) in home country::
Are you working in the United States?
If yes, what is your occupation (job) in the U.S. and where are you working?:	Occupation: Workplace:
Are you a student in the United States?
If yes, what is the name of your school and what are you studying?	School: Subject:
What level of Education have you completed?
Name of school in home country:
What type of visa do you have?

Who told you about the International Center? Please select one.
Name of referral source:

What are your hobbies or special interests?

Please give the name and phone number of an emergency contact:

Name:

Relationship:

Phone#:

PLEASE READ THE AGREEMENT BELOW BEFORE SUBMITTING:

The International Center in New York membership offers a variety of programs and services, but does not guarantee participation in all of them. Membership fees are not refundable and you can not give your card to anyone for any reason, including if you leave New York City or the United States before your membership card expires. All Center members must follow the rules and policies of the International Center as they are listed on the "Center Policies" board.

Do you understand the above agreement and do you promise to abide by it?

Yes