Pay Member Dues – Irish Channel No

NEW AND RENEWING MEMBERS PLEASE FILL OUT FORM

First Name*(Required)

Last Name*(Required)

Address*(Required)

Address* City* State*

Zip*(Required)

Country*(Required)

Telephone*(Required)

Fax

Email*(Required)

PAYMENT INFORMATION

Billing First Name*(Required)

Billing Last Name*(Required)

Address(Required)

Billing Address* Billing City* Billing State*

Billing Zip*(Required)

Country*(Required)

CREDIT CARD INFORMATION

Note: For those who paid 2025 dues your 2026 dues will be $100 on or before 12/31/2025  and $125 on or after 1/1/2026. For those who did not pay 2025 dues your 2026 dues are  $175 until 12/31/2025 and $200 after 12/31/2025

Charge Amount*(Required)

Credit Card(Required)

American Express

Discover

MasterCard

Visa

JCB

Maestro

Card Number

Expiration Date

Security Code Cardholder Name

Type*(Required)

Renewal

New member

Mail my medallion to the mailing address above for an additional $7.00

Total

Captcha

The Membership Fee for This Year is $200

(Dues will be $250 beginning January 1st)

NEW AND RENEWING MEMBERS PLEASE FILL OUT FORM

PAYMENT INFORMATION

CREDIT CARD INFORMATION

Application For Membership