Please complete this e-mail form to become a member at the International Center in New York and we will contact you to set up a registration appointment.
Membership Application
Note: All fields in red are required for submission.
Date: 
Prefix: 
Apt: 
Gender: 
Date Of Birth:  19
Country/City of Origin: 
Occupation (Job) in your country:
Occupation (Job) in the United States:
Are you working? 
If yes, where are you working? 
Are you a student? 
If yes, which school and what are you studying?  School:  Subject: 
What level of Education have you completed?
Arrival Date in the US: 
What type of visa do you have? 
Who told you about the International Center? Please check one.
   Current or Former Member - Who?  
      
   International Center Volunteer - Who? 
      
   A friend who is NOT an International Center Member or Volunteer
   Teacher or School - Which School?  
      
   Telephone Book
   Library - Which one? 
      
   Flyer - Where? 
   
   Newspaper or other publication - Which one? 
      
   Other (specify): 
      
How long have you studied English?
  years  months
 Where? 
Which programs at the International Center interest you?
    One-to-one partnerships
    English Classes
    American culture
    Practical (skills) workshops
What are your hobbies, or special interests?
   1. 
   2. 
   3. 
Please give the name and phone number of an emergency contact:
   Name: 
   Relationship: 
   Phone#: 
Please give your home country address if you are not a permanent resident of New York.

   Permanent home address: 

   Country:

Please indicate the days and times you are available for a one hour Orientation to the Center. Orientations give you information about our programs and services as well as a tour of the Center. They are offered Mondays through Saturdays.
   Time available: 

PLEASE READ THE AGREEMENT BELOW BEFORE SUBMITTING:

The International Center in New York membership offers a variety of programs and services, but that membership does not guarantee participation in all of them. The International Center membership is not transferable and membership fees are not refundable. 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