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VICA Membership Check Payment & Information Form

VICA uses this information for communication and planning purposes only. Contact information is never shared outside of VICA.

Please provide as much information as possible so that we may develop programs that are of interest to you.  Enter your membership information first and then complete the remainder of the form.

Click on the "Submit Form" button at the end to send the form. Send your check payment to:

VICA, P.O. Box 4054, Burlington VT 05406-4054

Thank you!

 

Membership & Contributions
Please select your category of membership. You can also contribute to VICA's Scholarship and Grants Fund or help support our operations with an additional donation if you desire. Or you can contribute to VICA without becoming a member. Please send a check for the total amount to VICA, P.O Box 4054, Burlington, VT 05406-4054
Please select the membership that matches your situation

Please enter an amount (without $ sign) that you wish to donate to our Scholarship and Grants Fund.

Please enter an amount (without $ sign) that you wish to donate to support VICA operations
Member Contact Information
(If a business membership, please enter your business name in the Address Line 2 field.)
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Prefix
First Name
Last Name
Suffix
*

*

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Address Line 1
Address Line 2
City
State/Province
ZIP/Postal Code
Country
*


If different from primary number

Alternate contact number

Person in same household to receive VICA news about upcoming events



Share with us your interests in Italian Culture
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Get Involved!
VICA can always use volunteers because we have no paid staff! Tell us how you'd like to get involved with VICA.
Get involved with VICA
How Did You Learn About VICA
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Check all that apply
Thank You!